How breast cancer treatment has evolved in Australia

Breast cancer treatment has come a long way in recent years, with Australian women now receiving a more targeted and personalised approach.

Cancer was the last thing on Barbe’s mind when she was diagnosed with the disease at the age of 39 in 2002. There was no family history and she thought she’d reduced her risk by breastfeeding three children, not smoking and leading a healthy lifestyle.

She was told she had HER2 positive cancer, a breast cancer caused when cells produce excessive amounts of the HER2 protein.

While the cancer hadn’t spread, it was aggressive, and she had to undergo surgery, chemotherapy and radiotherapy. 

Since then, breast cancer treatment has evolved even further. It’s now more targeted and personalised to match both the tumour and the patient. “It’s really important that from when I was diagnosed to now, we have a more personalised approach,” Barbe says.

Advancements in breast cancer treatment

While the most common treatments for breast cancer are still surgery, chemotherapy, radiotherapy and hormone therapy, these treatments themselves have improved, and continue to do so.

Professor Bruce Mann, surgical oncologist in Melbourne and director of research at Breast Cancer Trials, says treatments have come a long way from when having a mastectomy and removing glands was the common approach.

“Rather than breast cancer being seen as a single disease, we understand [now] there’s at least five diseases with different biologies that respond differently to hormonal blockers or chemotherapy or antibody treatments,” he says.

This increased knowledge is helping to develop new personalised treatment options, sometimes called ‘precision medicine’ or targeted therapies.

How new breast cancer treatment works

Personalised treatment for breast cancer aims to match treatments more closely to the type of tumour as well as the patient, rather than a ‘one size fits all’ approach. Tests may be conducted to analyse the tumour, which might include:

• Drug gene testing: looking at the way genes may influence how a patient’s body processes breast cancer medications.
• Tumour sequencing: testing the genetic make-up of cancer cells to help choose the best drug for the tumour type.
• Family history or genetic testing: can uncover inherited gene mutations that increase breast cancer risk, like the BRCA gene.

Treatments for early or advanced breast cancer varies from person to person, and is tailored by using information like the tumour’s molecular make-up, size, spread, patient’s genes and personal wishes.

Prof Mann says they look at the features of a tumour to help get an indication of whether a particular drug or set of drugs will work or not, which then informs the treatment plan.

Treatment for advanced (metastatic) disease

Metastatic (secondary) breast cancer is invasive breast cancer that has spread from the breast to other parts of the body. Metastatic cancer is also known as advanced or secondary cancer.

According to Prof Mann, new research shows that for each subtype of later-stage disease there are emerging drugs that may help improve the treatments.

Targeted chemotherapy options, including antibody-drug conjugates (which target and kill tumour cells while sparing healthy cells) are also being investigated to see if they can be used to treat advanced breast cancer.

“This is where a chemotherapy molecule is attached to an antibody that specially targets a cancer cell,” Prof Mann says.

These drugs also cause less damage to the healthy cells in your body, which can occur with other forms of chemotherapy, and could have potential for developing more improved and targeted treatments.

More personalised treatment options for advanced stage cancer can also help to reduce growth and spread of the cancer, relieve symptoms and reduce pain.

“If you’ve got a treatment that is effective against the cancer, it usually improves quality of life – not always, but usually,” Prof Mann says.

Minimising side effects

According to Prof Mann, minimising side effects for patients is one of the major benefits of personalising treatment.

“If you can have a treatment that is just as effective but with fewer side effects then that’s a good thing.”

Barbe experienced many of the common side effects of chemotherapy including dry skin, ‘fuzzy brain’ and hair loss, which she found particularly hard.

Radiation can result in similar side effects, causing fatigue, loss of appetite, digestive problems and a cough or shortness of breath.

For women undergoing hormone treatment, they may experience short-term side effects like tiredness, sweating, mood changes and weight gain. Longer term, it may cause osteoporosis and early menopause, and impact fertility and libido.

At-home treatment options

As more targeted treatments for breast cancer have developed, so has the understanding that it’s just as important to find the right care for the patient. “The other aspect to personalised treatment is working out what a patient wants, what’s right for them, as well as what’s right for their tumour,” Prof Mann says.

As a result, at-home therapy options are becoming more common.

Options include treatments that can be taken in oral (tablets or capsules) form, like some chemotherapy drugs. A patient’s doctor, nurse or pharmacist can help guide how and when a patient should take them, and how to handle the drugs safely at home.

Some patients may also be able to receive home-based intravenous (IV) chemotherapy. This is where chemotherapy is administered through a portable pump programmed to give a prescribed amount of chemotherapy continuously for up to a week. Patients seeking home-based IV chemotherapy increased during the pandemic by 50-80%.

“Telehealth and video health are also good developments,” Prof Mann says. “Often highly effective care, particularly follow-up care, can be delivered without the patients coming to the hospital.”

HCF offers a range of at-home options for eligible members through our at-home (HST) program^*. If your treating doctor agrees you can have IV chemotherapy treatment at home instead, we’ll work with you, your doctor and hospital to talk about getting the treatment you need in the comfort of your own home.

How to access personalised treatment options

With breast cancer treatments continually evolving, there can be a lot to keep up with – which is why multidisciplinary care is key. This means having access to a team of several different healthcare professionals to look after your overall health and help navigate the different options available.

If you have a multidisciplinary team as a breast cancer patient, those people can include:

• medical, surgical and radiation oncologists
• pathologists
• radiologists
• genetic oncologists
• breast care nurses
• allied health professionals including psychologists and physiotherapists.

A treating team that links in with your GP can also help ensure patients are looked after every step of the way through your treatment journey.

Reduce your risk, and be breast aware

Prof Mann says you can reduce your risk of breast cancer by making lifestyle changes like reducing alcohol intake, not smoking, being physically active and detecting cancer early. This is particularly important post COVID-19 lockdowns since some diagnoses were delayed during the pandemic.

Barbe found both her breast cancers herself – the first time while she was in the shower. She encourages women to know their breasts and be familiar with them so they can notice any changes.

How to check your breasts every month

The National Breast Cancer Foundation recommends:

• knowing how your breasts normally look and feel through regular activities (like showering, looking in the mirror and getting dressed)
• looking at and feeling your breasts (all parts and up to your collarbone) every month
• noticing any unusual changes (like a new lump, thickening, changes to the shape or size of the breast or nipple)
• being breast aware at all ages.

When to get a mammogram

Women aged 50-74 years are recommended to have a screening mammogram every two years. For women at high risk of breast cancer, screening may begin at a younger age and be more frequent.

During a mammogram your mammographer will check both of your breasts and usually take two X-ray pictures of each breast. This can be uncomfortable, but it only takes about 20 seconds.

Cancer Institute NSW recommends wearing a top you can take off and put on easily, and that you do not use talcum powder, deodorant or creams before your screening, as these can affect your result.

Talk to your GP if you have any symptoms or concerns.

Thankfully for Barbe, her days of treatment and hospital appointments are now in the past. “I just have regular check-ups with my GP now, I don’t need to go to an oncologist unless I have symptoms that I think need to be looked at (such as a persistent cough). Otherwise I like to think of myself as having the same risk of breast cancer as everybody else.”

Words by Tegan Forder
Published October 2022