In the middle of the celebratory Pink Cloud that we in the breast cancer business call October, I think we need to stop and recognize that we are all in this together.  Our collaboration with Susan G. Komen and Young Survival Coalition and our focus on the collateral damage of treatment has shown me how important solidarity is.  While there is room for subgroups based on biology (triple negative, metaplastic, Her 2 neu, phylloides, ER positive, lobular), stage (previvors, metastatic and DCIS), and ethnic or gender group (young, Lesbians, men, African Americans, Latinas, Asians, Persians), it is becoming very clear from the insights of the molecular biology and genetic analysis of tumors that our current categorizations may be more limiting and less accurate than we think.

A recent study showed that even cancers starting in different organs have many of the same genetic mutations.  It is not unlike infectious diseases, where in the past you had doctors who specialized in lung infections versus those who did kidney infections until we realized that the type of bacteria mattered more than the organ and that the treatment for strep is the same no matter which organ it is in!  In cancer, the driving mutations may be key and not the organs in which they occur.  Some stomach cancers overexpress Her 2 neu and respond to Herceptin, for example. In addition, recent data shows that cancers can indeed change their stripes. In other words, a tumor that starts out as one kind, such as estrogen positive, can recur as estrogen negative!  And even worse, not all the cancer cells in a particular tumor are the same.  This means that your tumor can harbor cells of more than one subtype and the one that is dominant and causing trouble can change over time!  If this is the case, it doesn’t make sense to look for the cause or even the cure of only one type of cancer, but to understand breast cancer as a whole.

The successful treatments for women with metastatic disease also point the way for early breast cancer treatments while vaccines being developed as treatments may teach us how to control, if not cure, cancers that have spread. We just don’t know what research will benefit which patient.

For this reason if no other, we need to be working all together to get better treatments with less collateral damage for everyone and to figure out how to prevent breast cancer from occurring in the first place!

It is with this in mind that I continue my quest to gather together the best and the brightest from all the breast cancer organizations to help us bring more focus on these issues.  We cannot slice and dice the research as a percentage being focused on one type or another but have to encourage scientists to look across the arbitrary boundaries of early versus metastatic and one molecular subtype versus another to look at ending it altogether. We are taking the first steps by including all women and men with and without a breast cancer diagnosis to participate in the Health of Women [HOW] study and to send us their collateral damage questions at  To those organizations that have joined us, thank you and for those still on the sidelines, we need you…all of you!  We can do this together and in fact, that is probably the only way we can bring about a future without breast cancer.

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5 Responses to The Balkanization of Breast Cancer

  1. Dr. Love is so wise in her comments about the dangers of Balkanization of the field of breast cancer. We must all avoid the pitfalls of tunnel vision and staking out “our territory” of influence. Thanks you, Dr. Love.

  2. With a focus on natural strategies for reducing cancer risks – occurrence, recurrence, risk of toxicities, combined with a strong understanding of the need for the so-called ‘alternative’ therapies, Annie Appleseed Project has always favored working with other groups. We reach out all the time to be inclusive. It’s a grand idea.

    We believe everyone with cancer, not just breast cancer, will benefit from our new program 3 Steps 4 Health. We suggest that eating 1 more fruit and 1 more vegetable every day, combined with taking a walk, and with deep breathing (7 breaths either before treatment or before bedtime) will make more people feel better,and handle conventional treatments better. It’s so simple to do.

  3. DrAttai says:

    Well said, as always. Collaboration and creative thinking are essential if we are to make true progress. Thank you for being such a tireless leader

  4. Susan Zager says:

    Thank you for your clear message that we are all in this together. We must educate the public so they understand that an estimated 155,000 Americans are currently living with metastatic breast cancer and each day there are 108 deaths in the US alone from this disease. Worldwide, we must get mets out of the closet. You bring so much hope by pointing out that “vaccines being developed as treatments may teach us how to control if not cure cancers that have spread” There is so much “collateral damage” from Stages 0-4. Your collaboration with the HOW study shows us how much we can all accomplish by uniting our efforts.

  5. I found this post through the facebook notification – which means I’ve also read women’s reactions to the concept that cancer takes lives. To be honest, before being diagnosed with stage 4, I avoided reading too much about metastatic breast cancer. It is a scary prospect, and one that does take away from ‘life after cancer’ we all crave so deeply.

    I think it’s deeply important to remember that early detection is not a cure. Cures need to address an issue that comes either BEFORE cancer happens, or when the disease progresses (along its various ways of progressing) to something that takes lives. As a group, I believe in finding a cure because then, and only then, do we really get to move forward and be free.

    For two years I was happily NED despite struggling with the idea of recurrence. Now I’m beyond that point to stage IV, and it is damn scary. Knowing awareness is being raised for the 30% who go on to metastasize is a comfort in itself. I don’t want more women to reach this point, and if they do, I’d like them to be comforted with breakthroughs and insights that are making the situation better.

    So yes, it’s scary and it’s not a happy note. And I don’t think women recovering from treatment need to focus on recurrence or think they will be sick again. But also, we shouldn’t forget those who are at that point and need our help. In supporting them (and me), we support the idea of really being free from cancer. I like the idea of being free from cancer. So there are my two cents! Great article, Dr. Love. ~Catherine

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