Oct. 11--JOHNSTOWN -- Dr. Paul V. Woolley remembers when a radical mastectomy was the only accepted treatment for the smallest breast cancer tumor.
"You took off the breast, all of the underlying muscle and all of the lymph nodes," Woolley said at Conemaugh Cancer Care Center in Johnstown.
Today, minimally invasive lumpectomies are the norm, illustrating one of hundreds of advances that have defined modern breast cancer treatment.
"If there is any disease that has undergone a revolution in treatment in 40 years, it's breast cancer," Woolley said.
Improved early detection through mammograms, ultrasound and magnetic resonance imaging, along with the development of chemotherapy and newer generations of drugs have more patients living longer, fuller lives.
It hasn't come easily, Woolley said, recalling when chemotherapy meant days in the hospital with debilitating nausea, vomiting and other side effects. But he's quick to point out that the real advances in cancer treatment did not even begin until the 1970s.
Like most progress, cancer research started with questions.
"People began asking: Is it really necessary to do all that surgery for the smaller lesions?"
Research soon proved that the answer is "no," because lumpectomies followed by radiation treatment are just as effective.
"The radical mastectomy is gone," Woolley said. "You just take out the lump. You don't have to take off the whole breast."
There were even more questions about Woolley's specialty: Medical oncology, which is the treatment of cancer with pharmaceuticals. As he went through medical school and his internal medicine residency in the 1960s, the subject was not even covered.
"It was a very different world back then," Woolley said. "I
didn't learn anything during my residency about taking care of cancer patients. The idea that we could treat cancer with drugs was totally foreign. There were people who didn't believe medical oncology was a real specialty."
For Woolley, that quickly changed in 1971 when he joined the National Institutes of Health as a cancer researcher.
The organization had been sponsoring cancer treatment research for more than a decade and the first proven results were just emerging.
One study showed a combination of four drugs known by the acronym MOPP significantly increased survival rates for Hodgkin's lymphoma.
Another showed lower mortality rates for breast cancer patients who received chemotherapy after surgery.
"The theory was, it killed tumor cells that were still circulating in the system," Woolley said. "Those two papers stick in my mind as the beginning of evidence-based medical oncology."
While the early studies proved drugs can fight cancer, they also opened a floodgate of more questions: What drugs are effective? At what dose? For how long? Are there different drugs for different cancers?
And perhaps most important: How can we reduce the side effects? Because side effects were brutal in the early days of medical oncology, Woolley said.
The problem is, cancer drugs are toxic. They poison the cancer, but also affect healthy parts of the body.
"For many people, the treatment was worse than the disease," Woolley said. "We didn't like it, but we were working with what we had."
Several developments have helped to reduce the side effects. Newer drugs have less toxicity to surrounding tissue; dosages and therapy schedules have been improved; and new drugs more effectively treat the side effects.
"Most of the patients do very well," said Dr. Ibrahim H. Sbeitan, Woolley's colleague at Conemaugh Cancer Center in Memorial Medical Center in Johnstown. "A lot go back to work while they still have the treatment."
The biggest advances are linked to a better understanding of the chemical makeup and actions of cancer cells within the human body, Woolley said.
A massive project in the 1990s resulted in the sequencing of the human genome.
Another project has been launched to map as many different cancer genes as possible.
The first study is already improving treatment, Woolley said, predicting that the two together will revolutionize treatment again.
"We are going to be able to see how cancer cells differ from regular cells," he said.
The explosion in molecular biology has already led to new treatments attacking enzymes or other substances produced by specific cancer cells that allow them to grow, multiply and spread.
Personalized, targeted therapy is becoming the norm for breast cancer patients.
"We have treatment tailored to the patient and her condition," Sbeitan said. "We study the tumor type and status of the tumor."
"We've got genes on a chip," Woolley said, describing a computerized test studying 16 genes in breast cancer. "The level of expression (of those genes) gives you an idea of the chances a woman's breast cancer is going to recur.
"Things we could only dream of are now reality. We are doing this right here in Johnstown."
The knowledge helps doctors recommend treatment following surgery, he explained.
"This whole field has just exploded," Woolley said. "Out of that has come a deeper understanding of the cells and what drives it and what differentiates a cancer cell."
But Woolley is quick to warn that the fight against breast cancer is far from over. When asked if there will ever be a cure for cancer, his answer is "no."
"There is not one disease," he said. "Cancer is a generic name for a whole host of diseases. There may be a cure for certain forms of cancer."
An experimental drug for treating the most deadly form of skin cancer, for instance, shows promise where nothing else has been effective.
"This gives a very good reason to think that some of the cancers we regard as very, very difficult to treat, may eventually be cured."
Breast cancer Q&A
Q: What are some risk factors for breast cancer?
A: Some of the risk factors that cannot be changed include race, age, a family history of breast cancer, early onset of menstrual period, having your first child after age 30 or having no children at all, menopause after age 55 and breast radiation before age 30. Lifestyle risk factors that an be modified include being overweight or obese, decreased physical activity, long-term use of hormone replacement therapy, alcohol consumption, smoking and poor diet.
Questions may be submitted to rgriffith@tribdem.com.
T-D's 'Pink Edition'
Welcome to The Tribune-Democrat's "Pink Edition" -- our third annual tribute to breast cancer awareness.
The printed version of this edition was printed on a pink background to draw attention to breast cancer prevention, treatment and research.
Our goal is that more of our readers will understand the risks of breast cancer and then attend screenings or have mammograms at local health facilities.
We thank our many sponsors -- whose ads you can find throughout this "Pink Edition." Without their support, our month-long awareness effort would not be possible.
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