Breathe
By Juana Ramírez
The impact of breast cancer in Mexico is significant. According to INEGI, during 2022 in our country 23,790 new cases of breast cancer were registered. In the same year, the total number of deaths from cancer in people over 20 years of age was 87,880 of which 9%, or 7,888 patients, died from breast cancer: 99.4% women and 0.6% in men. However, in the absence of a national registry of the disease and the difficulties of access to timely diagnosis and treatment, it is likely that this disease affects many more Mexicans.
Breast cancer also represents important challenges for public health, ranging from early detection, treatment and patient follow-up. That is why it is very important to add genomic analysis of patients in early stages to determine whether or not chemotherapy is the best therapeutic alternative, as well as to establish the origin of the disease in order to define the treatment. Let me explain.
Today, thanks to molecular genomics it is possible to know who is at risk for breast cancer, how external factors may influence this risk, whether or not breast tumors are likely to metastasize, and which subtype of tumors are likely to respond to which therapy. Fascinating.
Fourteen years ago I learned of a woman who would change the history of breast cancer and also my own: Dr. Laura van 't Veer, PhD, world renowned molecular biologist and inventor of "MammaPrint" a unique genetic study approved by the FDA that analyzes 70 tumor genes to determine the risk of patients to present recurrence or metastasis of cancer, with which doctors can determine whether or not chemotherapy treatment is necessary. In addition, the same study analyzes another 80 genes to perform molecular subtyping of breast cancer to determine the most appropriate type of treatment for each patient.
Dr. van 't Veer demonstrated that in breast cancer diagnosed at an early stage, 55% of patients are low risk and can safely forego chemotherapy -New England Journal of Medicine 2016-. Today her genetic test is included in the recommendations of the ASCO - American Society of Clinical Oncology- of the U.S., the NCCN -National Comprehensive Cancer Network, which in Spanish translates as Red Nacional Integral del Cancer-. The NCCN is a non-profit organization dedicated to research, education and the development of clinical guidelines for the treatment of cancer that are widely recognized and used by healthcare professionals around the world to improve the care and management of cancer patients; it has also been accepted by the AJCC -American Joint Committee on Cancer-, the organization that establishes the standards for the classification and staging of cancer, as well as the International St. Gallen -its European equivalent-. Today, Dr. van 't Veer is also the chair of the Biomarker Committee of the I-SPY 2 adaptive multicenter breast cancer clinical trial, which oversees the FDA-IDE "response predictive subtyping" companion diagnostic processes.
For the invention of Mammaprint, Dr. Laura van 't Veer received in 2007 the Lifetime Achievement Award of the European Society for Medical Oncology (ESMO), in 2015 the European Inventor Award, in 2017 the Clinical Research Award of the European Organization and in 2020 she received the Luminary Award of the World Conference on Precision Medicine and the Giants Of Cancer Care Award for Diagnostics.
In Mexico this test has been available since 2010 and although its use is still more widespread in patients in the private sector and with major medical insurance, this has been the result of the work of many people and especially of surgical oncologists who were pioneers in starting to use it in our country.
Recently Dr. William Audeh, researcher, medical oncologist and Medical Director of Agendia -the Dutch company founded by Dr. Van 't Veer and owner of the Mammaprint patent-, visited Mexico to present the most recent advances of this genomic study presented during the Annual Meeting of the American Society of Clinical Oncology (ASCO) held in San Francisco. During his lecture, Dr. Audeh commented: "The studies we recently published demonstrate the great impact that the MammaPrint genomic test has in identifying patients with early stage breast cancer who benefit more from extended hormonal therapy than from traditional chemotherapy, thus favoring patients and supporting treating physicians in clinical decision making.
In the same forum, Dr. Ernesto Sanchez-Forgach, renowned oncologic surgeon and leader of research in Mexico, presented the conclusions of the study "Genomic typing in Mexican patients with early stage breast cancer" which also includes doctors Eduardo Barragan Curiel, Sonia Flores, Cesar Gonzalez De Leon, Carlos Alberto Ramirez-Alvarado, Servando Cardona-Huerta, Fernando Cordera and Miguel Angel Lopez Valle among others. In this study presented at ASCO 2024 with the experience ofthe largest Latin American cohort with more than 1,673 patients published to date, it was possible to demonstrate the importance of performing genomic analysis in patients with breast cancer before initiating chemotherapy treatment, since, according to the results, 61% of the patients analyzed were at low risk of metastasis and therefore did not require chemotherapy. On the other hand, those who were found to be at high genomic risk received indispensable systemic treatment, which represents an enormous impact on the clinical decision-making process of breast cancer physicians, on the quality of life of the patients and, of course, on the costs associated with the treatment of this disease.
In her participation, Dr. Sonia Flores, the first female surgical oncologist in Nuevo Leon and one of the most influential women in the training of health professionals dedicated to breast cancer, emphasized the importance of performing genomic analysis of 70 genes in patients: "Although this neoplasm mainly impacts the population of women over 40 years of age, in recent years we have seen a higher incidence in young women from the age of 25, which already represents 14% of the total number of cases. These women are in the reproductive stage and in full professional growth and the consequences of chemotherapy in these patients, among others, affect their fertility. That is why it is so important to treat with chemotherapy only those patients who really need it, and this is impossible to determine exactly without a genomic test".
The next challenge is to make this diagnostic tool available in the public sector as well - at present, practically all insurance companies cover the use of Mammaprint for patients with private medical insurance - and its widespread use would represent an enormous benefit in the management of resources allocated to this disease.
The opinions expressed are the responsibility of the authors and are absolutely independent of the position and editorial line of the company. Opinion 51.
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