Philosopher and mathematician Alfred North Whitehead once remarked, “Science is not only stranger than we imagine but stranger than we can imagine.” For this reason, comments about the future of breast cancer research at the Miller School of Medicine, or in general, fill me with anxiety that some people may later compare what I write to what actually happens over the ensuing years. This anxiety is well founded given the great likelihood of enormous gains in a variety of technologies that will contribute to the diagnosis and treatment of this disease. Before looking ahead, it is certainly legitimate to point out the dramatic successes in managing this common malignancy. Over the past half-century the mortality of breast cancer has dropped from nearly 50 percent 50 years ago to approximately 18 percent today. Some of this decline is clearly attributable to early detection, mostly via mammography.

The greatest gain, however, has occurred through the use of adjuvant hormonal and/or chemotherapies. Appropriately delivered hormone therapies, such as Tamoxifen in premenopausal women and Aromatase inhibitors in postmenopausal women, reduce recurrence rates and improve survival 30 to 40 percent.

Chemotherapy has a similar beneficial impact. For women whose tumors are in part caused by over-expression of the HER-2 gene, trastuzumab (Herceptin) has even more dramatically improved survival.

As we look to the future, I believe breast cancer therapies will become more individualized. New strategies that allow examination of virtually all of the genes expressed by a given tumor have permitted the reclassification of breast cancer into at least six highly distinct subsets. Thus, therapies, which are relatively more useful in one subset or another, can be used with greater accuracy and less toxicity. It is inevitable that this process will be further refined with increasingly more precise technologies.

Furthermore, as we move into an era of so-called targeted therapy (therapy aimed at the actual expressed molecules that are responsible for the malignant behavior itself) such sub setting will permit greater individualization of therapy. As a trivially useful analogy, we do not use one antibiotic to treat every infection; we take advantage of sensitivity data from the microbiology lab to use antibiotics specifically targeting the pathways for growth employed by the pathogen of interest. In exactly that same sense, we will increasingly see the deployment of treatments that get at the root causes of breast cancer rather than the more nonspecific cytotoxics currently used.

One prediction is that breast cancer research will be more intertwined with research in other malignancies, and vice versa. As an example, a single drug recently developed to target a growth factor responsible for tumor vessel formation not only has shown substantial success in breast cancer but has worked in at least eight other tumor types that make use of the same molecule to promote vascular growth.

The Braman Family Breast Cancer Institute at UM/Sylvester has already generously begun to support the recruitment growth of a cadre of breast cancer investigators. It is through their zeal and enthusiasm to not only communicate their own research—and also through their multiple interactions in the clinic and in the lab—that they will unquestionably provide significant new ideas for even more successful control and eventual eradication of breast cancer, something I firmly predict will occur over the next 20 years.

Marc E. Lippman, M.D., is chairman of the Department of Medicine and one of the nation’s leading breast cancer researchers.