Gay Rudis’ brush with breast cancer has fueled her desire to help stamp out the disease by volunteering with the Virginia Breast Cancer Foundation. Photo by Chris Smith
Gay Rudis learned she had cancer in her right breast the day after Thanksgiving in 1995. Only 43 years old at the time, Rudis immediately thought of her mother, who had been diagnosed with breast cancer at age 48 and died at 51. "It's scary knowing my mother only lived three years after they found the cancer," the Henrico County resident says. "Once you have breast cancer, you are at high risk to get it again."
Rudis went through the standard regimen of surgery, radiation and chemotherapy. She had hoped the cancer was gone, but in 2007 she discovered she had cancer in her left breast. After a mastectomy and treatment, Rudis is now cancer-free, but her brush with the disease has fueled her desire to help stamp out breast cancer once and for all.
As a volunteer and immediate past board president for the Virginia Breast Cancer Foundation , Rudis is helping the organization work toward the goal of eradicating breast cancer by 2020. The foundation is participating in the National Breast Cancer Coalition's campaign to gather 290,000 signatures (representing the estimated number of people who will be diagnosed with breast cancer in the United States this year) on a petition that will be sent to President Barack Obama by Election Day. The group is asking him to introduce legislation in the Senate and House that would commit resources to the 2020 goal.
In Virginia, the foundation hopes to collect 7,911 signatures. Chapters around the state are taking petitions to various locations, including churches and treatment centers such as the VCU Massey Cancer Center. "We want to figure out how to get a vaccine to prevent the disease," says Vernal Branch, the foundation's public policy manager. "In order to prevent it, we would have to find out what is causing it."The foundation has been involved in legislative work during the last 20 years to improve the health of women dealing with breast cancer. The organization has successfully advocated for Medicaid coverage for mammography and for statewide legislation to ensure Medicaid coverage for breast reconstruction and a 48-hour hospital stay after a mastectomy. Each year, the organization gives out the Sharon H. Kohlenberg Healthcare Service Award to Virginians in the health care field who are committed to fighting breast cancer. (The award is given in the memory of Kohlenberg, a health-care administrator and co-founder of the foundation, who died from breast cancer in 1993.)
Breast cancer is the second leading cause of cancer death for women in the United States, after lung cancer. According to National Cancer Institute estimates, 39,510 women will die from breast cancer in 2012. A woman in the United States has a one in eight chance of developing it during her lifetime. That number is up from 1975, when the risk was one in 11. Doctors can't pinpoint the exact reason for the increase, but believe it could be due to better screening methods and more women getting screenings. But even though the chance of getting breast cancer has gone up, the number of deaths from breast cancer has decreased slightly. "We haven't found a way to stop cancer or prevent it, but we can reduce the death rate," says Dr. Ellen Shaw de Paredes, founder and director of the Ellen Shaw de Paredes Institute for Women's Imaging and the 2001 recipient of the Kohlenberg award. "More women are being cured of cancer."
Detecting cancer in the breast in its earliest stage is one of the best defenses against the spread of the disease. A large-scale Swedish trial with results published in the journal Radiology last year showed that breast cancer screening with mammography results in a significant reduction — about 33 percent — in breast cancer deaths. The goal is to "find cancer as early as possible before it has a chance to go anywhere else in the body," Paredes says. "When we make recommendations about screening, we are looking at the overall risk of developing breast cancer. If a patient has higher risk factors such as family history, breast cancer or pre-cancer, we recommend additional imaging in addition to screening mammography. That could be a breast ultrasound or MRI."
One risk factor that has received attention recently is breast density, which can obscure a mass on a mammogram. "Dense breast tissue is more common in younger women," Paredes says. "There is a new state law [Virginia HB 83] that requires all mammography facilities to inform mammography patients if their breast density is increased on mammography." Recent evidence shows that a woman with dense breast tissue has four to six times-greater risk of breast cancer. "Increased density may be caused by fibrocystic changes, hormonal effects, medications, weight loss and breast masses," Paredes says.
Women with dense breast tissue may benefit from tomosynthesis, a new form of digital mammography that takes multiple X-rays of the breast, creating a 3-D image. "It can find a small cancer in dense tissue," Paredes says. "We will probably see it in Richmond in the next year."
Clinical trials play a pivotal role in the fight against breast cancer. Dr. Harry Bear, chairman of VCU Medical Center's division of surgical oncology, director of the Breast Health Center at Massey Cancer Center and 1995 recipient of the Kohlenberg award, sees promise in the clinical trials being conducted for breast cancer.
"We have a wide array of new targeted therapies that have been discovered by molecular analysis," he says, noting that the current methods of treatment include surgery, radiation, chemotherapy, hormonal therapy and targeted therapy. "Treatments have dramatically improved, particularly the new targeted therapies. They are a more directed approach that attacks breast cancer cells without harming other cells."
After her second bout with breast cancer, Rudis was given a drug called trastuzumab, a targeted therapy drug found useful in clinical trials for treating cancer that is HER2-positive. (HER2 stands for human epidermal growth factor receptor 2, a protein that over-expresses itself in breast cancer). "In the 12 years between my two diagnoses, there were several clinical trials that had been done that I benefitted from," she says. "I feel like the trastuzumab really helped me. I appreciate the women who participated in the clinical trial."
The purpose of the trial was to see if trastuzumab would prevent breast cancer from returning if it was added during standard chemotherapy for early stage HER2-positive breast cancer. "We saw marked improvement in outcomes," Bear says, noting that drugs such as trastuzumab can block cancer growth.
Another promising clinical trial studies the advantages of using molecular profiling to decide whether chemotherapy or hormonal therapy is the better choice for treating patients to shrink a tumor before surgery. "The hormonal therapy has fewer side effects than the chemo," Bear says, adding that a related trial looks at using the same molecular profiling method to decide whether or not patients with positive lymph nodes should receive chemotherapy after surgery. In yet another clinical trial, researchers are testing Viagra, which might help prevent heart damage among women receiving certain chemotherapy drugs.
In their fight to eradicate breast cancer, the Virginia Breast Cancer Foundation and the National Breast Cancer Coalition are focusing on two key areas: Learning how to prevent breast cancer from spreading and how to stop the disease from developing. The coalition has established the Artemis Project to develop and implement a five-year strategic plan for a preventive breast cancer vaccine.
Some institutions, such as The Cleveland Clinic, the University of Texas and the University of Pennsylvania, are already working on vaccines.
Can the goal of eradicating the disease become a reality by 2020? Paredes and Bear have their doubts. "We have made significant improvements, but we are not on the brink of getting rid of it," Bear says.
Paredes agrees. "I would like to think that it could. Right now we need to focus on detection, early treatment and tailored treatment to the tumor and patient as well as prevention."