Research and cures
At Edith Sanford Breast Center, we are pioneering a smart, innovative approach to breast cancer. Our mission is to unlock each woman’s genetic code, advance today’s prevention and treatment, and end breast cancer for future generations.
We are committed to advancing breakthrough genomics research to identify the most precise treatments for each person, prevent the disease on an individual basis, and ultimately end breast cancer.
Edith Sanford is committed to advancing cutting-edge translational genomics research to identify speciﬁc treatments that will work best for each person, prevent the disease on an individual basis and, ultimately, end breast cancer.
By leveraging the resources and vast patient network of Sanford Health, the largest rural health system in the nation, Edith Sanford is uniquely positioned to accelerate lifesaving discoveries from the lab to the clinic, and into communities.
What sets Edith Sanford apart?
- We will advance genomics research to dramatically improve breast cancer prevention, treatment and survivorship.
- We will conduct the research, collaborate with others and share our ﬁndings.
- We will be the ﬁrst to drive knowledge into communities through personalized genomics, raising the standard of care everywhere for breast cancer treatment and prevention.
Our breakthrough approach
Through our dynamic partnership with Sanford Health, what is discovered in the lab can be quickly translated into individualized patient care. This model eliminates traditional barriers and puts researchers, physicians and patients on the same team, working toward the same goals. Essentially, Edith Sanford is in the center of an entire ecosystem designed around unlocking the potential of genomics and genetics to end the pain and suffering of disease.
A genomics hub where discoveries are shared
Collaboration and data sharing are keys to knocking down silos and speeding the research process. High-caliber partnerships with research leaders, such as the Athena Breast Health Network, are positioning Edith Sanford as a national hub supporting genomic research, clinical trials and risk reduction, where brilliant scientiﬁc minds will have access to the most innovative tools, technology and infrastructure in the county.
Leading-edge biobank to accelerate discovery
There is great urgency behind our mission to end breast cancer, and for that reason, everything about the Edith Sanford initiative is designed to streamline and accelerate the research process. That includes putting resources and technology at the fingertips of our researchers and physicians so that patients can benefit as soon as possible.
Edith Sanford’s biobank — a repository of blood and tissue samples from volunteers of all ages and backgrounds — gives researchers ready access to the genomic information found in human DNA to better understand the genetic and molecular changes involved in the progression of breast cancer.
Without this state-of-the-art resource, researchers needing specific samples would need to gain approval from an Institutional Review Board, find the patients and extract and catalog the samples on their own, adding months to a research project.
Genomics and breast cancerFor many years cancer research has revolved around a powerful, elusive word: cure. We’ve been raising funds, wearing pink, and walking miles for a cure; we’ve been waiting, praying, hoping for a cure. The focus has been on one single solution to the big, deadly problem of cancer, but as we now know, the answer is far more complex.
Recently, the language and the mission of cancer research has shifted as we understand more about how cancer develops and grows. Scientists have learned more about the unique way that cancer manifests in each person, driven by genetic mutations and the interaction of multiple genes within the complex code that makes up our individual DNA.
This knowledge has fueled the current commitment among researchers to crack these codes to reveal additional lifesaving genetic information and to develop treatments that target the genetic changes that cause cancer cells to grow.
This new approach to research has led to a transformational shift in how we think about treating cancer: instead of finding one cure, we are cracking a code to deliver many different highly personalized treatments that can and will save lives.
Genetics vs. GenomicsYou’ve probably heard of genetic testing for cancer susceptibility, but the more recent and broader field of genomics is beginning to dramatically change our understanding of what cancer is and how it can be treated.
- Genetics is the study of single genes and their effects. For example, certain inherited mutations in the BRCA1 or BRCA2 genes greatly increase a woman’s risk of breast and ovarian cancer. If a woman tests positive for a BRCA mutation, there are steps that she can take to reduce her cancer risk or to detect cancer at an early stage. Mutations may also be spontaneous, which unlike inherited mutations, means that they occur for other reasons during your lifetime.
- Genomics generally refers to the study of the entire genome (all of the DNA in an organism). Genomics can consider multiple genes and how they interact with each other and the environment to affect health. Genomic information is already guiding treatment decisions for certain types of cancer—including breast cancer—and the field is expanding at a rapid rate.
It Starts With DNAThe story begins with DNA (deoxyribonucleic acid)—chemical information that is stored in the nucleus of each of our cells. You can think of DNA as being made up of two connected strands of letters. The way in which these letters are ordered and grouped to form words and sentences controls how our bodies are made and maintained.
Within each cell, DNA is packaged into several separate pieces called chromosomes. Each chromosome, in turn, consists of many genes. A gene is a stretch of DNA that has a particular function; usually, this function is to make a protein. Proteins form the basis for the structure and function of our bodies.
DNA SequencingBy sequencing DNA — gathering information about the letters of the code within cancer cells and normal cells — scientists have begun to identify genomic changes that characterize certain types of cancer. This is expanding our understanding of the tremendous variability of cancer, and is also pointing the way toward better diagnostics and treatment.
As the tools for DNA sequencing have improved, it’s become possible to evaluate much more of the genome. Rather than looking at only a single gene or a small number of genes, it’s now possible to evaluate the entire genome. Whole exome sequencing and whole genome sequencing are examples of this broader approach to DNA sequencing.
- Whole exome sequencing: The exome refers to all of the pieces of DNA that provide instructions for making proteins. This makes up roughly one percent of the genome. This type of sequencing is an efficient way to look for many of the currently known disease-causing mutations. A limitation of this approach, however, is that it misses DNA variations that occur in other parts of the genome.
- Whole genome sequencing: Whole genome sequencing overcomes the limitation of whole exome sequencing by collecting information about all of the letters in an individual’s genetic code. This expands the number and types of genetic variations that can be detected.
Breast Cancer and GenomicsWhat is breast cancer?
Breast cancer is the most commonly diagnosed cancer in U.S. women, with more than 232,000 cases diagnosed each year. Survival has improved over recent decades, but the disease continues to kill roughly 40,000 women each year.
Breast cancer usually starts with the abnormal growth of cells in the ducts or lobules of the breast. As the cancer grows, these cells can invade nearby normal tissue and can also spread to other parts of the body.
Today we understand how complex breast cancer is at every level. It’s not a single disease, but many different diseases with tremendous variability in how they grow and respond to certain types of treatment. Currently, breast cancers are commonly tested for characteristics such as estrogen receptor (ER) status, progesterone receptor (PR) status, and HER2 status. These characteristics provide information about some of the pathways that drive the growth of the cancer, and also help guide decisions about the use of hormonal therapies and HER2-targeted therapies.
How is genomics changing our understanding of breast cancer?
For research purposes, breast cancers are often divided into at least four broad categories. These categories describe breast cancers that show different patterns of growth and behavior.
- Luminal A: Hormone receptor-positive, HER2-negative, low Ki67
- Luminal B: Hormone receptor positive and HER2-positive (or HER2-negative with high Ki67)
- Basal-like/triple negative: Hormone receptor-negative and HER2-negative
- HER2 type: Hormone receptor-negative, HER2-positive
This, in turn, can point the way toward new, more effective, and more individualized types of treatment. Progress in this area will be particularly important for the subtypes of breast cancer that currently have a poor prognosis and few treatment options, such as triple negative breast cancer.
How is genomics changing care for breast cancer?
As noted above, several breast cancer characteristics have long played a role in treatment decision making. More comprehensive genomic testing, however, will provide more detailed information about tumor behavior.
Researchers recognize that patterns of gene activity within a tumor can provide information about how aggressive a tumor is likely to be. Rather than assessing only a single characteristic of the tumor, gene expression tests can evaluate several genes at the same time. For example, for women with early-stage, estrogen receptor-positive breast cancer, this type of testing can provide information about the likelihood of cancer recurrence and the likely benefit of chemotherapy. Use of this type of testing is likely to expand.
There’s Still Work to DoAlthough genomics is already changing the way in which breast cancer is classified and managed, there is still a tremendous amount that we don’t know. Rapid progress is being made, however, offering the hope of evermore individualized treatment and longer, cancer-free survival.
- National Human Genome Research Institute. Frequently Asked Questions About Genetic and Genomic Science. Available at: http://www.genome.gov/19016904 (Accessed September 18, 2013).
- Gray J, Druker B. The breast cancer landscape. Nature. 2012;486:328-329.
- Balko JM, Stricker TP, Arteaga CL. The genomic map of breast cancer: which roads lead to better targeted therapies? Breast Cancer Research. 2013;15:209.
- Genetics Home Reference. What advances are being made in DNA sequencing? Available at: http://ghr.nlm.nih.gov/handbook/genomicresearch/sequencing. Accessed September 30, 2013.
- American Cancer Society. Cancer Facts & Figures 2013.
- Paik S, Tang G, Shak S, et al. Gene expression and benefit of chemotherapy in women with node-negative, estrogen receptor–positive breast cancer. J Clin Oncol. 2006;24:3726-3734
It’s not enough just to understand breast cancer; it’s important to understand your breast cancer.
In the past, we saw breast cancer as one disease, but now we know better. Breast cancer is a general term used to refer to cancer that occurs in the breast, but there are actually several different types of breast cancer, each driven by its own set of underlying biological factors.
Because each breast cancer is unique, breast cancer treatment must also be unique—and there has been a distinct shift to fighting cancer at the molecular level. In fact, there is even a name for it: personalized medicine.
Personalized medicine is the result of ongoing research into the genetics, genomics and molecular biology of cancer. As we deepen our understanding of the underlying biology and behavior of cancer, we develop more personalized and targeted ways to treat it.
Your cancer is uniqueHistorically, breast cancer was simply “staged” (how big is it and where is it in the body?). Of course, staging is still important, but now in addition to staging, we can identify molecular subtypes of the cancer. This additional information helps guide treatment, enabling doctors to provide personalized medicine.
In order to identify the individual “fingerprint” of a breast cancer, doctors will look at many characteristics of the cancer:
Stage is a measure of the extent of the cancer, and is based on the size of the tumor and the presence or absence of local or distant metastases (cancer spread). There are several important variables in staging breast cancer:
Invasive vs. non-invasive: Noninvasive breast cancer, also called “in situ,” refers to cancer in which the cells have remained within their place of origin and have not spread to breast tissue around the breast duct or lobule. There are two types of noninvasive cancer:
- Ductal carcinoma in situ (DCIS) is considered precancerous and could develop into invasive cancer if not removed.
- Lobular carcinoma in situ (LCIS) is not considered precancerous.
Invasive breast cancer refers to cancer that has spread outside the membrane that lines a duct or lobule, invading the surrounding tissues. Breast cancer that has reached stages I to IV is considered invasive.
Size The size of a cancer helps determine its stage. Smaller cancers are considered earlier stage cancers and are often more treatable. For example, a stage I cancer is smaller than 2 centimeters and has not spread outside the breast, whereas a stage III cancer may be 5 centimeters with spread to the lymph nodes.
Lymph node involvement Determining whether cancer has spread to the lymph nodes is an important part of staging. When lymph nodes contain cancer cells, there is an increased risk of the cancer spreading. The more lymph nodes that contain cancer cells, the more serious the cancer might be.
Aggressiveness Aggressiveness is determined based on how cancer cells look under the microscope. It is measured by the degree of difference between cancer cells and normal cells and graded on a scale of 1 to 3, with grade 3 cancers being the most aggressive.
Approximately 20 percent of breast cancers overexpress (make too much of) a protein known as HER2. Overexpression of this protein leads to increased growth of cancer cells. It is important to accurately measure HER2 status in all breast cancers because there are targeted treatments for HER2-positive cancers.
Hormone receptor status
Some breast cancer cells express an abundance of receptors for the female hormones estrogen and/or progesterone. These hormone receptor-positive breast cancers are typically associated with a better prognosis and are treated differently from breast cancers that are hormone receptor-negative. Patients with hormone receptor-positive breast cancer often receive treatment with hormonal therapy (such as tamoxifen or an aromatase inhibitor).
Breast cancers can be classified as estrogen receptor (ER)-positive, progesterone receptor (PR)-positive, or hormone receptor-negative.
Among women with early-stage breast cancer, the expression, or activity, of certain genes has been linked with the likelihood of cancer recurrence.
There are three genomic tests available to measure gene expression and predict the likelihood of recurrence: Oncotype DX, MammaPrint, and Mammostrat. Based on the results of these tests, women are assigned a Recurrence Score (for Oncotype DX) or a risk index score that predicts the risk of recurrence. Women at a higher risk of recurrence may benefit from more aggressive treatment, whereas those with a lower risk may be spared additional treatment.
The right treatment at the right timeUnderstanding all of the characteristics of a woman’s breast cancer—including the genomics—enables doctors to customize treatment to target the specific characteristics of the cancer.
No longer is a woman simply diagnosed with breast cancer. Now, the cancer is identified as either estrogen receptor (ER)-positive or ER-negative and HER2-positive or HER2-negative. This additional information is fundamental to guiding treatment.
Women with HER2-positive cancer will benefit from treatment with the targeted drug Herceptin® (trastuzumab), whereas those with HER2-negative cancer will not. Similarly, women with ER-positive cancer may benefit from hormonal therapies designed to suppress or block estrogen, whereas those with ER-negative cancer will not.
What’s more, there are three genomic assays — Oncotype DX, MammaPrint, and Mammostrat — that are designed to examine the genetic structure of a woman’s breast cancer and predict its behavior. These tests may help guide decisions about whether additional treatment with chemotherapy or radiation therapy is necessary after surgery. Individuals with high-risk cancers may require more aggressive treatment, while those with low-risk cancers may be spared from unnecessary treatment.
The importance of clinical trialsClinical trials are studies that evaluate the effectiveness and safety of new drugs or treatment strategies.
What do clinical trials have to do with breast cancer treatment? A lot, actually. Most new treatments are developed in clinical trials. All new cancer drugs that are currently available in the United States were once only available in clinical trials.
Clinical trials are essential to advancing new and innovative treatment strategies. In fact, personalized treatment strategies—such as Herceptin or hormonal therapy—are now available to breast cancer patients as a direct result of the clinical trials process.
In order to develop more effective breast cancer treatments, it is important that patients continue to participate in clinical trials. Participation in a clinical trial may offer access to better treatments and advance the existing knowledge about treatment of this cancer.
Clinical trials are available for most stages of cancer. Patients who participate in a clinical trial can expect to receive the best current standard treatments available or new treatment strategies that may one day become standard treatment. In some cases, the best cancer treatment may be available only in a clinical trial.
- National Human Genome Research Institute. Frequently Asked Questions About Genetic and Genomic Science. Available at: http://www.genome.gov/19016904 (Accessed April 16, 2014).
- Paik S, Tang G, Shak S et al. Gene Expression and Benefit of Chemotherapy in Women with Node-Negative, Estrogen Receptor-Positive Breast Cancer. Journal of Clinical Oncology. 2006; 24(23): 3726-3734.
- Solin LJ, Gray R, Baehner FL, et al. A multigene expression assay to predict local recurrence risk for ductal carcinoma in situ of the breast. Journal of the National Cancer Institute. 2013; 105(10): 701-710.
- Smith, I, Proctor M, Gelber RD et al. 2-year Follow-up of Trastuzumab after Adjuvant Chemotherapy in HER2-positive Breast Cancer: A Randomised Controlled Trial. Lancet. 2007;369:29-36.
- Davidson NE, Osborne CK. Adjuvant Endocrine Therapy for Early-stage Breast Cancer. In: Govindan R, ed. American Society of Clinical Oncology 2007 Educational Book. Alexandria, VA: American Society of Clinical Oncology; 2007:96-99.
- Howell A, Cuzick J, Baum M et al. Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) Trial after Completion of 5 Years’ Adjuvant Treatment for Breast Cancer. The Lancet. 2005;365:60-2.
Risk factorsEach year, more than 232,000 women in the U.S. are diagnosed with breast cancer.1 That means that about every two minutes, another woman has her life turned upside down by this disease.
While there's no surefire way to prevent breast cancer altogether, there's a lot we can do to protect ourselves from the disease. (more…)