Era of Hope

editorial George W. Sledge, Jr., MD Division of Hematology/Oncology Indiana University School of Medicine Indianapolis, IN

Era of Hope The United States Army’s Breast Cancer Research Program recently celebrated its 10th anniversary of congressional funding in Orlando, Florida, with a meeting aptly titled Era of Hope. The meeting brought together clinicians, basic scientists, and breast cancer advocates who have been involved in the program, including both current and past recipients of the program’s awards. The 10th anniversary of such a program allows one to pause for a moment to consider the past decade and what it has meant for the breast cancer community. By any measure, it has been a momentous decade, both in terms of our understanding of the basic biology of the disease and in terms of the treatments available. As a little experiment, I researched when some of today’s commonly used terms first entered Medline with regard to breast cancer. The results, shown below, are fascinating and give us some sense of how far we have journeyed in the past decade.

Table 1 Year in Which Terms First Appeared in Medline Term

Year

Paclitaxel

1991

Docetaxel

1992

Cyclin

1992

Sentinel lymph node

1993

Anastrazole

1994

Telomerase

1995

Genomics

1996

Proteomics

1998

Trastuzumab

1998

Fulvestrant

2001

Note: first year in Medline with regard to breast cancer.

In addition, the past decade has seen the approval of numerous agents for the treatment of breast cancer by the US Food and Drug Administration. Prior to the past decade, there had been a long drought with regard to new agents in breast cancer since the approval of doxorubicin in the late 1970s. The past few years have seen the approval of new chemotherapeutic agents (eg, the taxanes and capecitabine), new hormonal agents (eg, the aromatase inhibitors and fulvestrant), and an entirely new class of agents (eg, the HERtargeting monoclonal antibody trastuzumab), as well as supportive care agents that prevent the complications of therapy (eg, antiemetics and hematopoietic growth factors) or of breast cancer (eg, bisphosphonates). Several of these agents not only entered our armamentarium for metastatic disease but have also completed phase III trials in the adjuvant setting. Have they also made a difference from a public health standpoint? I think so. The past decade is the first since we began collecting detailed mortality data to actually demonstrate a decline in the rate of breast cancer deaths (both in relative and absolute terms). This decline almost certainly came about as a result of one of two factors: early detection and surgery or curative therapy for microscopic metastatic disease. Not that we are anywhere near the day when we can call this battle won; far too many women still die of breast cancer, and breast cancer incidence (as opposed to mortality) continues to increase. But I do believe, given what we have seen and what I think we can expect, that this is indeed an era of hope.

George W. Sledge, Jr., MD Editor-in-Chief

Clinical Breast Cancer October 2002 • 237