Two professors from the George Washington University are breaking new ground in breast cancer research that may help diagnose and treat the disease more effectively.
According to a new study led by Heather Hoffman, an associate professor of epidemiology and biostatistics in the School of Public Health and Health Services, patient navigation – a service that helps patients overcome barriers to getting health care including setting up appointments, dealing with health insurance and easing fears – can reduce potentially dangerous delays in the identification of breast cancer. The study was published in the October issue of “Cancer Epidemiology, Biomarkers & Prevention,” a journal published by the American Association for Cancer Research.
“The time savings really paid off for the women in this study,” said Dr. Hoffman. “A quicker diagnosis of breast cancer often translates to faster treatment and might give women a better shot at survival.”
Another GW professor, Sidney Fu, is researching new methods of early breast cancer detection. Dr. Fu, a professor of medicine in the School of Medicine and Health Sciences, received a two-year, $362,060 grant from the National Cancer Institute to conduct research using novel small RNA (microRNA or miRNA) biomarkers. In less than a decade, miRNA has become one of the most important sets of regulatory molecules in the body. Because the deregulation of these small RNAs is associated with cancer initiation and development, and because they circulate stably in blood, they have great potential as diagnostic and/or prognostic biomarkers for cancer and other diseases. Dr. Fu hopes to use these biomarkers to develop a blood test to determine with greater precision whether a patient carries cells that will eventually turn into breast cancer.
Breast cancer generally develops in the cells surrounding the milk-producing breast ducts. Somehow, either through internal or environmental factors, those cells gradually change in a patient who may develop breast cancer. Initially, cells will just accumulate. At this point, they are normal cells, which are called hyperplasia. If the cells continue to progress, they then become abnormal and enter into the atypical ductal hyperplasia (ADH) stage. At the ADH stage, cells look abnormal under the microscope, but they are not cancer cells. If cells continue to progress into the ductal carcinoma in situ (DCIS) stage (the most common type of non-invasive breast cancer), the cells then become cancer cells.
Today, patients with early-stage breast cancer are usually diagnosed after a mammogram. This method of detection, however, can lead to overtreatment since mammography cannot determine which women diagnosed with DCIS will eventually develop invasive breast cancer. That’s why Dr. Fu hopes to discover novel biomarkers to help physicians determine whether or not a patient diagnosed with DCIS should be treated rigorously or with simple follow-ups.
“If we can identify the miRNA signatures in DCIS, which can be used to differentiate between patients whose cells may eventually develop into invasive breast cancer and those patients whose cells will never develop into cancer, we would be able to eliminate unnecessary surgery and/or chemotherapy and radiation therapy for those patients who will not benefit,” said Dr. Fu.
Breast cancer kills more than 40,000 women every year in the United States and is a particular problem in the District of Columbia — a city that struggles with one of the highest breast cancer death rates in the nation.
GW is part of a national multicenter Patient Navigation Research Program (PNRP), which is funded by the National Cancer Institute. As part of the GW arm of the PNRP, Dr. Hoffman analyzed the time delay patients experienced between a suspicious finding and a diagnostic result. Dr. Hoffman and the PNRP research team, which included seven other D.C.-based cancer health organizations, wondered if patient navigation might help reduce lags in diagnosis and treatment.
The researchers discovered that patient navigation services shaved days off the time it took to get a diagnosis. For example, women who received patient navigation services got a breast cancer diagnosis on average 25 days after learning they had a breast lump. In contrast, women who did not receive patient navigation got a breast cancer diagnosis on average 42 days after finding a breast lump – a delay that slows down the initiation of treatment.
Because the study only included 2,601 women in D.C., Dr. Hoffman said additional research is needed to determine whether women in other cities or in rural areas will get a similar time advantage when offered patient navigation services.
The study also found that patient navigation had an even stronger effect on women who needed a biopsy and women who did not have health insurance. Uninsured women often have trouble finding health care providers who will treat them, Dr. Hoffman said, and they also face other barriers to care, including a lack of transportation to the clinic or childcare.
“Navigators follow up with women and encourage them to go on for additional tests until they get an answer either one way or the other,” Dr. Hoffman said, adding that many women feel overwhelmed or paralyzed by fear when they find a breast lump or get a mammogram with an abnormal result. “With help, many women are able to move forward to get the care they need.”