Breast and Ovarian Cancer: New Hopes, Longer Life.(Cover story)

Byline: Carolyn M. Kaelin, M.D., M.P.H.; Arlan f. Fuller Jr., M.D., and Francesca Coltrera (Kaelin and Fuller are on the faculty of Harvard Medical School. Kaelin is the author, with Coltrera, of "Living Through Breast Cancer" (McGraw-Hill, 2005). For more information on breast and ovarian cancer, go to health.harvard.edu/NEWSWEEK.)

An estimated 213,000 new cases of breast cancer and 20,000 new cases of ovarian cancer will be diagnosed in the United States in 2006. Together, the two diseases will kill more than 56,700 U.S. women this year; the yearly toll comes to well over a million women worldwide, according to a 2002 World Health Organization study. The statistics are sobering, but the good news is that recent breakthroughs in treatment are boosting hopes and improving survival rates for women facing these terrible foes.

Much of the progress is based on our growing knowledge of cancer genetics. Several currently available targeted drugs, like Herceptin and the aromatase inhibitors, are already proving effective for early-stage as well as advanced breast cancer. And more than 60 breast-cancer drug trials are underway, with more potential treatments in the pipeline.

Of course, these so-called targeted therapies require targets. Estrogen, which fuels cell growth in roughly two thirds of breast cancers, and a protein called HER2/neu, which prompts aggressive tumor growth in approximately 20 percent of women with breast cancer, have provided major bull's-eyes for targeted drugs. Pinpointing other likely targets has been a slow, hard slog. But recent developments--including a landmark discovery called the HapMap, which makes it easier and faster to identify likely disease-causing genes, and a burgeoning government-financed project, the Cancer Genome Project--are speeding the process.

New science is also improving older treatments. Until recently, most breast-cancer patients had to subject themselves to the rigors of chemotherapy. While many benefited, some suffered needlessly from the scattershot action of powerful drugs that destroy rapidly dividing cells throughout the body--including healthy cells. Now an analysis of three large, randomized chemotherapy studies published in the April 12 Journal of the American Medical Association strongly suggests that women who reap the largest benefit from chemotherapy are those whose cancers are not fueled by estrogen. Additionally, a new type of genetic testing better predicts which early-stage breast-cancer patients are likely to benefit from chemotherapy.

Drug advances are only part of the story. New research ...