Photo of Shelley Hwang, MD, MPH, Chief of Breast Surgery wearing a mask and goggles during breast surgery.
Shelley Hwang, MD, MPH, Chief of Breast Surgery Photo credit: Shawn Rocco/ Duke University

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<p>North Carolina’s cancer centers push the boundaries of research into the dreaded disease.

By Thomas Goldsmith

Radiation. Cancer chemotherapy. Lumpectomy. Mastectomy. Could all of these interventions be overkill for many women with breast cancer?

A “wait and watch” approach to the breast condition known as DCIS may be more appropriate for many women than more aggressive treatment, said a Duke physician recently.

Surgeon Shelley Hwang (right) with one of her patients. Photo courtesy: Twitter/ @DukeCancer

The setting for those remarks was an annual breakfast presented Nov. 10 in Durham by the American Cancer Society’s Cancer Action Network with the goal of celebrating achievement and raising awareness and funding for research in the field. Representatives of North Carolina’s three National Cancer Institute-designated comprehensive cancer centers updated brought on recent progress, each citing a team-based approach.

Shelley Hwang, a surgeon at the Duke Cancer Institute, spoke about her role as a principal co-investigator in a $13.4 million study of low-risk ductal carcinoma in situ, or DCIS. The condition, affecting 60,000 American women annually, involves cancerous cells contained in the ducts of the breast, that have not yet spread, Hwang said.

“We treat it very much like we do cancer, and it has very much the same treatment side effects,” she said. “It really hasn’t brought about the reduction in breast cancer we would like to see.”

Hwang: Some patients treated too aggressively

Based on cooperation among different medical and scientific disciplines, Hwang said, clinicians have been asking questions about when treatment for such conditions is warranted and when an aggressive approach might outweigh benefits.

“Why are these people continuously radiated and treated … and potentially have both breasts removed?” she asked. “The alternative to this would be close monitoring, with treatment only if the patient develops cancer.”

Hwang said if a woman is 60 years old and diagnosed with DCIS, “You are much more likely to die of non-breast cancer related causes.”

The U.S. health care system currently spends $250 million annually treating DCIS, in many cases without strong evidence to justify the treatment, said Hwang, who was recognized along with Dr. Laura Esserman, of the University of California, San Francisco, as one of Time magazine’s 100 most influential people of 2016.

According to the National Cancer Institute, DCIS is: “A noninvasive condition in which abnormal cells are found in the lining of a breast duct. The abnormal cells have not spread outside the duct to other tissues in the breast.” Image courtesy: NCI

Musician Melissa Etheridge, a breast cancer survivor, told Time she applauds the trend toward less invasive treatment.

“… I’m happy to see doctors like Laura Esserman and Shelley Hwang, who are at the top of their field, saying, ‘Whoa, let’s put a brake on all these radical surgeries,’ Etheridge said in the magazine. “Maybe there is a middle step. Let’s try that before we go to the radical step.”

Hwang also touched on trials involving PVS-RIPO, a genetically engineered poliovirus that is being investigated as a new anti-cancer agent at Duke.

Trials using mice, and some people, have shown good results against some brain tumors.

14 million survivors

Lance Miller, core director of the Wake Forest Baptist Comprehensive Cancer Center, outlined growth and progress at the center, where professionals are organized into disease-oriented teams.

“We have organized in teams to try to confront them in a cross-disciplinary mode,” said Miller. “Team science is the future of cancer research.”

Dr. Chad Ellis, associate director at UNC-Lineberger Comprehensive Cancer Center, noted that

80 percent of all children diagnosed with cancer will be cured of their disease and that two-thirds

of adults diagnosed with the disease will live at least five years.

“There are 14 million cancer survivors alive in the United States,” Ellis said.

UNC is recruiting people from across the scientific and academic spectrum to examine how the disease affects different population groups, Ellis said. A related area of intense activity is personalized medicine, where clinicians determine the specific treatment that will cure a cancer, but not harm the patient.

“We identify the particular characteristics of a tumor in a patient … and we pick exactly the right treatment,” Ellis said.

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What is a NCI-designated Cancer Center?

UNC, Duke and Wake Forest are each home to one of 47 U.S. comprehensive cancer centers designated by the National Cancer Institute, the principal federal agency for cancer research.

The designation recognizes the centers for their “scientific leadership, resources, and the depth and breadth of their research in basic, clinical, and/or population science.” To merit the  “comprehensive” designation, a center must demonstrate additional depth and breadth of research, as well as research that crosses disciplinary lines.

The National Cancer Institute, set up by federal legislation in 1937, is part of the National Institutes of Health, one of 11 agencies under the federal Department of Health and Human Services.

Source: National Cancer Institute

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Thomas Goldsmith

Thomas Goldsmith worked in daily newspapers for 33 years before joining North Carolina Health News. Goldsmith is a native Tar Heel who attended the UNC-Chapel Hill, and worked at newspapers in Tennessee...