Host
Heather Simonsen, MA
Public Affairs Senior Manager
Huntsman Cancer Institute
Jessica Rivera
Breast cancer survivor
Phoebe Freer, MD
Radiologist, Huntsman Cancer Institute
Associate professor of radiology, Ï㽶ÊÓƵ of Utah
Senior director, basic science at Huntsman Cancer Institute
Professor, oncological sciences at the Ï㽶ÊÓƵ of Utah
Episode Transcript
Topics by Timestamp
- Jessica Rivera’s Story: A Life-Saving Mammogram (00:14)
- From Diagnosis to Breakthroughs: Advancing Breast Cancer Care (03:34)
- Breast Cancer Trends: Understanding Rising Rates in the U.S. (05:34)
- Unveiling the Causes Behind Rising Breast Cancer Rates (06:23)
- A Guide to Breast Cancer Screening: Breast Cancer Recommendations (07:40)
- Evolution of Breast Cancer Imaging (11:34)
- Shaping the Future: How AI and Innovation are Revolutionizing Breast Cancer Imaging (15:23)
- Dr. Freer’s Journey: Passion and Purpose in Breast Cancer Care (19:05)
- Jessica’s Journey: Navigating Breast Cancer Diagnosis and Treatment (23:06)
- Pioneering Breast Cancer Research with Dr. Alana (26:35)
Jessica Rivera’s Story: A Life-Saving Mammogram (00:14)
Heather Simonsen: Hello and welcome to delivering a cancer free frontier. I'm your host, Heather Simonsen. When Jessica Rivera turned 40, she scheduled her very first mammogram.
Jessica Rivera: This felt like sort of a box to check, if you will. That you know, in the same way that I'm moving forward in care for my kids, I need to be moving forward in care with myself.
Heather Simonsen: Jessica is a mom of two. It was a busy time in her life. Her kids were in elementary school at the time, and she had just started her own business as an interior designer.
Jessica Rivera: I didn't anticipate that there were going to be any issues. I mean, the biggest health events or milestones in my life were having my wisdom teeth removed, and I actually gave birth to my son in the car on the way to the hospital. But like by and large, I felt healthy. There was never really any indication that I should consider something otherwise. It is probably going to be a little bit uncomfortable, but you're going to come out of it okay on the other side, that's just kind of the price of admission.
Heather Simonsen: But not long after the X ray, Jessica realized something was wrong, the technicians asked her to stay in the waiting room.
Jessica Rivera: You know, we think we have found some things, and we want to figure out what we found, and so we need to kind of schedule a biopsy.
Heather Simonsen: She remembers looking at the images.
Jessica Rivera: I mean, it's like a white spot, right? Because the back is dark and you can see, like the mass on the screen. So that was, again, it just I felt like I was not really even in my body at that point. Like there's such a shock, because you're just going about your life, being a mom and raising your kids, and I just started a business, and was like, really stepping into an uptick. And so it felt like it was the best of times, it was the worst of times, and there was such a such a strong contrast there, that it just felt like my world was turned upside down.
Heather Simonsen: Jessica's mammogram was just the beginning of a long journey, one that would take her through treatment here at Huntsman Cancer Institute. But the day of her mammogram, she didn't know that yet.
Jessica Rivera: And it was trying to then figure out what was happening, what to anticipate? And just all of the sudden, shifting from kind of worrying about everybody else to really like, oh my gosh, this is happening to me. How am I going to work through this? How am I going to deal with this? What is going to happen? And I have said before, and I will say it again, I feel like that mammogram saved my life.
From Diagnosis to Breakthroughs: Advancing Breast Cancer Care (03:34)
Heather Simonsen: On today's episode of delivering a cancer free frontier, we're going to talk about breast cancer advancements in screening, treatment and research here at Huntsman Cancer Institute. According to the , one in eight women will develop breast cancer at some point in their lives. It's a staggering statistic. The numbers are much lower for men, but in 2025 it's estimated that 2800 men will also be diagnosed with invasive breast cancer. For many women like Jessica Rivera, screening is the first step in finding the disease. These days, most people are familiar with the idea of getting your mammogram, an x ray that can be used to diagnose breast cancer, but it has taken decades of public health advocacy to get to this point.
Phoebe Freer: People used to not even want to say they called it the C word, or they would whisper and not say, cancer.
Heather Simonsen: This is Dr Phoebe Freer. She's a radiologist at Huntsman Cancer Institute and associate professor of radiology at the Ï㽶ÊÓƵ of Utah, and an expert in breast cancer screening.
Phoebe Freer: And , who was first lady at the time, actually had a breast cancer, and she spoke about having breast cancer, and kind of made it a national thing to be able to talk about it.
Heather Simonsen: Here's Betty Ford herself at the opening of , another Comprehensive Cancer Center in 1976.
Archival: My mastectomy and the discussion about it, I was really pleased to see it, because it prompted a large number of women to go and get checkups in their local communities.
Heather Simonsen: It wasn’t until the 1990s that breast cancer screening really took off. Now Dr. Freer says screening is more important than ever.
Breast Cancer Trends: Understanding Rising Rates in the U.S. (05:34)
Phoebe Freer: So, breast cancer remains at epidemic levels in both the United States and worldwide. We know that the breast cancer background incidence is steadily increasing. Since the 1940s we've made great advances in detection of breast cancer. We've made marked advances in the treatment of breast cancer. We have not done anything to prevent breast cancer on a large scale, public health standpoint, and that incidence is continuing to rise.
It's continuing to rise in men. It's continuing to rise in women under 30 and women in their 30s, and it's continuing to rise in women of screening age who are 40 and over. And so, it's about a half to 1% per year growth every year of more breast cancers. And that's not just finding it earlier. Those are the actual background increases.
Heather Simonsen: That's discouraging, and we don't know why?
Unveiling the Causes Behind Rising Breast Cancer Rates (06:23)
Phoebe Freer: We really don't know why we've made some progress for patients who are of sufficiently high risk, patients who might have a gene abnormality, like the that we do have some prevention. You can have , where you have bilateral mastectomies. They're actually what's called chemo prevention, where you can take a medication that changes your hormonal status and decreases the risk of breast cancers. You can have , where your ovaries are removed if you're of sufficiently high risk, and that decreases your both ovarian cancer and breast cancer risks.
But those are pretty extreme maneuvers, and so those are are reserved for the, you know, extremely high risk patients. They're not for the average patient, for the average patient, we really don't know. There's some public health things that people aren't as aware of, such as alcohol, that does make a difference. So especially 10 years ago, you know, I moved here from the East Coast, and on the East Coast, people thought they were being healthy if they had a glass of red wine with dinner, thinking that they were helping their heart health, or things that way. We now know that a glass of wine with dinner that would be seven drinks a week. We know that more than six drinks a week almost doubles your risk of breast cancer.
So, you do want to keep alcohol to a minimum. Obesity and lifestyle factors can make a difference. Nutrition can make a difference, but there really are a lot of unknown factors.
A Guide to Breast Cancer Screening: Breast Cancer Recommendations (07:40)
Heather Simonsen: So, what are the current recommendations for women and breast cancer screening?
Phoebe Freer: That's a great question. So, the Huntsman Cancer Institute multi-disciplinary panel, as well as the , recommend that women get screened starting with mammogram at the age of 40, and get screened every year. Those are for average risk patients. Some patients need more than that, and so the recommendation is also that women have risk stratification, usually by the around the age of 30, so that we don't miss patients and find out if they are of higher risk, and if they're higher risk, they may need to start screening earlier, and they may need to screen with other tests, such as MRI or additional testing.
Heather Simonsen: So just put it on your calendar at age 40 and above, for sure, once a year.
Phoebe Freer: Yep, so age 40 and above once a year. The recommendations just walked their recommendations back from 50 to 40. They still say that it's possible to do it every two years. What's interesting is, if you actually look at their data in their report, they acknowledge tremendous number of more lives saved doing it every year. We don't want to pick and choose which lives to save here at the Huntsman Cancer Institute or as breast radiologists, so we really do want to recommend screening every year. It's important for women to know, the more they get screened, the more likely they are to have a test called abnormal.
So, if a woman knows that she's kind of prepped that it's not unusual to be called back for additional testing. That additional testing is usually just an additional mammogram, a few more pictures, maybe an ultrasound. The majority of those patients are told they're fine once they get that imaging, some are put into a follow up, and only a small percentage of those would end up needing a biopsy. But if a woman knows that's part of the process of screening, it can help alleviate some of the anxiety that comes with that.
I usually tell patients, try to make it fun if you can, because women aren't great at taking care of themselves. Historically, they're so busy taking care of everyone else and everything else, that if you can schedule the mammogram either with a friend and go out to lunch and you know, that's your day, you go together. There's some women who do that, or go with a sister, a mom, or make it a day that you go and you get your nails done, or you get a massage, or you go on a shopping trip. Something that kind of rewards yourself and says, oh, this is my mammogram day and also, something fun happens on that day. That way you're not dreading it as much and can look forward to it a little bit more.
Heather Simonsen: I love that recommendation, especially it makes it, you know, a positive. And like you said something you don't dread.
Phoebe Freer: Because if you know, I remind women, if that if a cancer is there, it's going to be there whether or not she gets the mammogram, and it's going to be growing whether or not she gets the mammogram. So, it can be a scary time to go and look. So, you know, it's not unusual for some people to live in denial say, oh, I don't want to, I don't want to go look and kind of ignore it. The longer things get ignored, the harder they are to treat. So, if a cancer is there, we actually do want to go ahead and look. And just that usually sets a woman up to get back to living a normal life.
Evolution of Breast Cancer Imaging (11:34)
Heather Simonsen: And how has breast cancer imaging evolved over, say, the last 20 years?
Phoebe Freer: So, breast cancer imaging is actually a really exciting place of growth. So, the standard of care is mammography, which has been around for decades. And so, in some ways, it's kind of the same that it has been, and our mammography is better than it used to be. We used to do film screen mammography, and in 2005 a large study came out showed digital mammography, you know, essentially, kind of using computers, if you will, can make a difference for women with dense breasts, and was at least equal to, if not better than, film screen. So, we transitioned to that.
But then really exciting throughout my career, I was able to train at an institution and then stay at an institution that actually was responsible for the development of 3d mammography, which technically is not 3d but it's breast tomosynthesis, and it's multiple planes, multiple images through the same plane, kind of like paging through a book, if you will. And you look at all the pages of a book, as opposed to just the cover of a book, it is a mammographic technique, so it's an x ray technique, but it's low dose mammograms, and it's a series of mammograms that gives us tremendous more information. It gives us better cancer detection as well as keeps a patient from being called back unnecessarily. We've made great progress in breast MRI.
So, in the early 90s, people started doing breast MRI for high risk patients, those kind of BRCA gene carriers, patients with sufficiently high family history. Our technique for the breast MRI has just improved significantly since then. So, if you go back and look at some those old MRs, you know, it's like, wow, how did you even read those at the time. We've made great progress just in the last five years with breast MRI technique. The cancer detection rate on breast MRI is significantly higher. So, for people who do qualify because they're high risk, or people with extremely dense breasts, it really has made a huge difference in our ability to detect those cancers and dense breasts.
Heather Simonsen: Just to back up a little bit, it's not something you can tell by feeling the breast. It has to it's a mammography term correct, because dense breast tissue shows up as white and so does a tumor.
Phoebe Freer: Yeah, so that's correct. The breast density is a term that's used based on a mammographic definition, and it's essentially how white does the patient tissue look on mammogram versus how dark it looks. Fat is dark on a mammogram, and it's easy to see through.
A woman can't control her breast density that much. Nutrition plays a part. Hormones play a part. So, people who are on estrogen or hormone replacement therapy will have higher breast density than people who go through menopause and don't take hormones. People who gain weight, obviously you're gaining fat in the breast and not gaining breast tissue in the breast, so that can change your breast tissue density. But you can have, you know, overweight women with dense breasts. You can have women in their 80s with extremely dense breasts. So, it's it doesn't always, always correlate perfectly.
The problem with breast density is twofold. Number one, and the biggest one is what's called a masking phenomenon. So, I like to think it's kind of like looking through foggy windows or through that kind of frosted glass tile, where you can't really see behind a window clearly. If you, if you wash the window and have clear glass, you can see through it really clearly what's behind it. You know, otherwise you might just see a silhouette. It might be a little foggy.
The second problem with breast density is that patients have a slightly higher risk of breast cancer. But women who have dense breasts shouldn't be alarmed. It's a normal finding, and it's about 44 to 48% of women have dense breasts. The majority of women in their 40s or pre-menopausal have dense breasts. So, it's a normal phenomenon, if you will, only about 10% or less than 10% have that extremely dense breast tissue.
Those are the ones that are hardest to see through, and those are ones who, very recently, American College of Radiology appropriateness criteria said that maybe those women might actually benefit from MRI screening in addition. It's a new thing for that to be in the United States. Not all insurances are going to cover it in all states at this point, and having the resources for that, having enough MRI, is going to be tricky. We know already in the women who are super high risk and qualify for MRI to begin with, we're only capturing about 20% of those women.
We're now moving forward with giving contrast with mammography that uses an IV and it puts in the same kind of iodinated contrast dye that's used in CT scan. Those tests are actually pretty easy to read and fast to read, so you do get the IV for the contrast. Now that this new recommendation has come out, it likely will take a while before we catch up, and that's a place where maybe contrast mammography might make a difference.
Shaping the Future: How AI and Innovation are Revolutionizing Breast Cancer Imaging (15:23)
Heather Simonsen: So, what's the future of breast cancer imaging? I mean, what comes next?
Phoebe Freer: Yeah, so one of the big things coming is AI, so artificial intelligence. And starting January 2025, we'll be implementing AI for breast imaging at Huntsman Cancer Institute, We've had CAD for a long time, Computer Aided detection. AI is a much-improved version of CAD. So, it can point out if there's a mass you know, that it thinks might be a cancer, and start to give percentages of cancers, of it being a cancer, or can point out calcifications or things that way. But it also takes the finding and puts it in the context of the patient's breast tissue pattern.
And for some AI can also put it in the context of that patient's risk stratification based on other questions that the patient may answer in terms of family history or previous breast history. And one of the things that we've been kind of looking to as those of us who read a lot of breast imaging, is what you really want to do is you want, you want some type of computer program that could look at a negative mammogram that does not show a cancer and actually say, yes, indeed, this is negative.
And if we can screen all of those out, then you can use the trained expert radiologist to look at those that did not fall into the negative basket and say, you know, look at these higher risk ones, and then what do you see? So that might change the nature of the breast radiologist a little bit, and that you're really trying to discern very tough tissue patterns. You know what you're looking through. We're at really kind of the nascence of AI, right? Like the CAD was around for a while, but this AI is new. And if we think, gosh, it's already this good, you know, what is, what is it going to look like in the next, you know, 15-20 years, I think that's a place that's really exciting.
Heather Simonsen: And can you tell me a little bit more about how you would see AI really assisting us to go to the next level in mammography?
Phoebe Freer: Yeah, well we know that we are not great as a population and as healthcare, as getting all patients who need to be screened, screened. So, we in Utah actually are pretty abysmal at screening. So, we're one of, usually the, you know, in the bottom five of states in the nation, and the Intermountain West is similarly like that. Some of that is an access problem. You know, if you have a rural and frontier population, those patients don't have as much access. And so that's, you know, one place that we're doing a lot of work with, Huntsman Cancer Institute, and it's five state NCI designation, trying to really help improve access for women.
And we have the Huntsman Cancer mobile screening and just have another one coming online in January 2025 as well to improve cancer screening access. But some of it is a function of resources, especially when you're talking about additional screening. So those women trying to come in for breast MRI, that takes resources to a whole different level of both insurance and costs, as well as access to an MRI, which are much fewer and further between than having the mammograms.
If we can appropriately weed out negatives, we might be able to even say some patients are of such sufficiently low risk based on that mammogram and based on risk stratification, that we might be able to really do more precision breast cancer screening, and say, maybe some patients don't even need to be screened every year. Maybe some patients could be screened every two years or every three years, and then maybe other patients need to be screened every six months and have more.
So, it might be able to help us allocate those resources more accurately in a way that helps the people who need it get more and helps the people who don't need it maybe, maybe get a little bit less.
Dr. Freer’s Journey: Passion and Purpose in Breast Cancer Care (19:05)
Heather Simonsen: I can tell you're so passionate about your work, I'm curious what drives you?
Phoebe Freer: So that's a great question. I always liked medicine. My dad was an ER doc, and I would remember going to his office sometimes, and we'd see, like the his books and go through while we were waiting for him, like pictures of snake bites or things like that. And I thought that was kind of fun and exciting, but I thought, gosh, why in the world would you want to work so hard? And then I actually my passion for medicine was struck by when I was a patient in a car accident.
So I was 19, junior year of college, day before Thanksgiving, and I was T boned as a passenger by a guy at an intersection going 55 miles per hour. Got cut out by the jaws of life, was in the ICU for a few days, and was in the hospital for a couple weeks, and then my parents were great and made a kind of rehab hospital at home for me. And multiple pelvic fractures, multiple rib fractures, liver injury, kidney injury, but I was super lucky, and that that made me realize, oh, this is why you would work so hard. I was, it was all of a sudden, not just kind of fascinating to look at a picture of a snake bite, but it was also, you know, kind of a mission.
And so, it's my it's my duty and my mission, and the more we can continue to get the word out, continue to research and continue to educate. You know, I think there's not a lot I'm good at in the world, but this is one thing I know, so I feel the need to continue to learn and help our women.
Heather Simonsen: I admire that so much, and I really appreciate you sharing your story. I mean, 19, that's a that's a tender age, but it sounds like you use that as fuel.
Phoebe Freer: I feel incredibly fortunate to have a career that I feel driven, you know, to come to work, and it's fulfilling, and I wanted to be able to focus on a disease where we could really make a difference. And the evidence behind mammography and breast cancer screening and breast imaging is just tremendous. And it's one of those things where you can really feel that you're making a difference with where we currently are, with the data and the medicine, and yet, there is a lot of room for growth to continue to make a difference.
People sometimes now, you know, I talked about AI sometimes, as AI comes out, people say, well, you know, aren't you scared that'll get rid of your job? And I'm like, fine, that's great, right? Like, I'm sure I'll find something else to be interested in. But if we solve the problem of breast cancer early detection or find a way to prevent it, that's great. So, you know, there's still so much work to be done, though, before that happens.
Heather Simonsen: I loved our conversation today. Thank you for being.
Phoebe Freer: Yeah, thanks for having me. I think the advocacy continues to be important.
Heather Simonsen: One more thought with Dr. Freer, before we go, I ask her what she would say to women like Jessica Rivera. Women who are going in for their very first screening and afraid of hearing life altering news.
Phoebe Freer: The majority of women who are sitting in the dressing room waiting for their mammogram are a little bit nervous, wondering whether or not they might be that patient that could happen to. I think it's anxiety provoking time to come get your mammogram for those women, where we do find something, I remind them, 85% of women with breast cancer do well long term. Screen detected breast cancers usually do well.
We have really good data accumulated for hundreds of 1000s of women over decades now that the earlier we can treat a breast cancer, the better that woman does long term. So, it's not just that we're finding that cancer and we are just finding it earlier and therefore she's living longer, it's that we're finding it earlier, and can intervene with treatments at that point, and those treatments actually extend her life.
It can be a scary time for a woman, but we try to walk patients through the next steps, help make the next appointments easier, guide patients through the next parts of treatment. Most women coming for screening with screen detected cancers. Don't have advanced cancers, and that's why we want to find the med screening.
Jessica’s Journey: Navigating Breast Cancer Diagnosis and Treatment (23:06)
Heather Simonsen: That's what happened to Jessica Rivera. Her mammogram caught her tumor early, and she was eventually diagnosed with two types of cancer,
Jessica Rivera: , which they refer to as DCIS, which is a pre cancer, and then the other type of cancer that they found was IDC, which is , and that was hormone driven. So, it's . Essentially, the cancer was growing or feeding off of the estrogen and progesterone in my body.
Heather Simonsen: She was a stage one patient, but she was stage one, grade three, a measurement that showed her cancer could spread quickly. With the help of her team at Huntsman Cancer Institute, Jessica decided on the best course of treatment for her needs. Luckily, her cancer hadn't spread beyond her breast.
Jessica Rivera: I decided on a unilateral . So that means we I just had one breast removed instead of instead of both.
Heather Simonsen: She could have moved forward from there by just taking tamoxifen, a drug that would block the estrogen from her cancer, but she opted for more treatment.
Jessica Rivera: I also wanted to really move through this experience without any regrets that I could have done something more. So, I opted for the big guns. I went for the really big chemotherapy. I am now five years out from my initial diagnosis. I think there's so much as women that sort of society puts on us, or places on us, or that have come through generationally of kind of how we're supposed to show up in the world. And the statistic is one in eight in terms of a breast cancer diagnosis and that's pretty astounding.
I have the privilege of saying in my position, like, what a gift that got to be in terms of shaping my perspective, and sort of like rising from the ashes as a phoenix, like, literally, like I felt like the chemotherapy was, like, I scorched middle earth, my body right? Like, I just, I needed a reset. My check engine light came on, and I needed a reset. And I really needed to kind of sit with this experience and figure out who and how I wanted to move forward.
And I feel like the number of cancer, you know, women with breast cancer, is sort of on the rise. And in this sort of really macro perspective, I feel like it's sort of a call to action for, like, this really big shift in being able to find our voices and advocate for ourselves, instead of always trying to take care of everybody else like that, care has got to start with you.
Heather Simonsen: Thank you so much to Jessica Rivera for sharing her story.
Pioneering Breast Cancer Research with Dr. Alana (26:35)
Heather Simonsen: Screening is the first step in finding breast cancer. Then comes treatment. But behind the scenes, there's another element to cancer care, the work of an army of scientists trying to better understand cancer at the molecular level. If they can do that, the hope is they will find better drugs and therapies for patients. We spoke to , one of Huntsman Cancer Institute's researchers, about the progress in the field and the work she's doing in her lab.
Alana Welm: What I would say to patients, and I do say to patients all the time is that we're working really hard to try to find new therapies and to use the therapies we have in a more personalized way.
My name is Alana Welm, and I'm senior director of basic science here at Huntsman Cancer Institute and professor in oncological sciences. We’re definitely moving in the right direction in breast cancer. Fifty years ago, people didn't talk about it, and then we went through this phase of massive treatments and being now tailored down to, you know, surgical lumpectomies, for example, instead of radical mastectomies, to a point where the public was very aware of breast cancer because of the screening campaigns and early detection campaigns, everybody get their mammogram. Now, the advances in our breast cancer treatments are better drugs for smaller and smaller sub populations of patients.
Many people feel that breast cancer research has led to cures in breast cancer, which it has. But I think many people don't appreciate how many people still die from breast cancer, talking about five people every hour, just in the US will die of breast cancer. The deadly forms of breast cancer are those that spread to other organs, and sometimes even patient families don't really understand that when someone dies of that disease, that they're dying of breast cancer. I often hear patient families say, oh, they died of, you know, liver cancer. Really it was the breast cancer that spread to the liver or to the brain or to the lungs, etc.
Bench to bedside research is a form of translational research that we strive for, where you make a discovery at the laboratory bench, that's where that comes from, and then eventually translate it into clinical trials or the bedside of a patient. It's also important, though, to know that translational research also goes in the opposite direction. So, we have what we call bench to bedside and back where we take a clinical problem that occurs for a patient and then go into the research lab to try to understand that problem and come up with a solution. So, we actually do both in my lab, and some of our work was has really been inspired by that bedside to bench concept.
I am studying how the disease spreads to other organs, because that's the deadly form of breast cancer. My assumption as a scientist, because we knew that that was an important process, and we were studying, is that patients, after they completed their treatment for breast cancer, would be screened for the appearance of those metastases, but what I learned is that that actually doesn't happen unless the patient has a symptom. And the reason for that is because an earlier detection of that metastatic spread does not actually change the outcome. And that was really counterintuitive and surprising to me and made me realize that we needed to have better ways of knowing at the time of diagnosis whether that cancer had the ability to spread or not.
And the way we ended up being able to do that was through a serendipitous observation that if we could grow the tumor in mice in the lab, those were the cancers that eventually spread by metastasis and caused death of those patients. Less aggressive tumors could not grow in a mouse. And the way I think about that is it's actually a lot to ask of a tumor. It's a big feat for a tumor to grow in a foreign environment, which is essentially what we're testing, but that's really the same thing as metastasis. When a breast tumor spreads to the brain or to the liver or anywhere else, it has to learn how to grow in a foreign environment, and only a fraction of tumors can do that, those are the most aggressive ones. But because that was an accidental observation, we realized that in order to really prove that fact, we would need to do what we call a prospective clinical study.
We developed the TOWARDS trial, and this was , and myself, Cindy Matsen, MD, Christos Vaklavas, MD, , there's been many people who have been involved in this. And the idea was, could we, based on the features of someone's initial breast tumor, figure out a way to determine how aggressive that cancer was?
What we did is we said, Okay, we'll enroll women who are newly diagnosed with breast cancer, take a biopsy of their tumor before they start treatment, of course, if they agree to be on study, and then we'll implant it in the mice and then see if we can prospectively predict the recurrence based on the engraftment behavior of the tumor. And we found that we could so the ability to grow in the mouse was prognostic for distant recurrence and actually death from breast cancer.
In breast cancer, we think this is mostly applicable for a certain subtype of breast cancer called . Triple negative breast cancer essentially means the absence of three things. That's why it's called triple negative. And it's the absence of two hormone receptors, the estrogen and progesterone receptors, as well as the absence of a growth factor called and that's important because the breast cancers that express the hormone receptors or HER2 are able to be targeted with therapies that target those particular entities.
Triple negative breast cancer, by definition, doesn't have those and therefore cannot be targeted through those drugs. Once we realized that engraftment of a person's tumor was going to correlate with their disease recurrence and their unfortunately poor outcome, we thought we should do something about that. And so that's what led us to the precision medicine programs that we're working on now, which is we're growing the person's tumor.
So, can we actually try to determine which drugs might work for that person's tumor? So, it's a very, very individualized intervention where we try to optimize therapy based on the growth and response of their tumor to drugs. But now we have so much data about the mutations that are in these tumors, which drugs they responded to, whether or not the tumor grew in mice that what we want to build, and what we're doing now is machine learning.
So, this is where artificial intelligence comes in to integrate all that past data from all those trial participants and all of our research that we've done to date in order to develop predictive algorithms. So that now you can just take someone's tumor, you can analyze the mutations and the gene expression, and then just put it into the algorithm, and it will predict how aggressive the tumor is, and which drugs would work. So that's the futuristic view. We're not there yet, but that's what we're building now.
When I started my lab here, I had no idea that I would be doing the work that I'm doing now. I had, of course, I think, a very good plan about the type of research I would do to better understand breast cancer metastasis. But coming here to this environment was what changed everything, because, like I said, I spent some time in the clinic. That bedside to bench awareness really shaped the research that we do, being able to have close collaborations with clinical colleagues and even with patients, has really affected the type of research that we do. And so, there's no way that I could have ever imagined that, because it really depended on the environment that is so unique here. So, I think we're really in a sweet spot to make a huge difference.
Heather Simonsen: Thank you to Dr. Phoebe Freer, Dr. Alana Welm and Jessica Rivera for joining us today. For more information on breast cancer screening, treatment services and research, please visit our website, healthcare.utah.edu/huntsmancancerinstitute, and remember, get your mammogram.
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