When military scuba divers are in training, they learn to hold their breath deep in the lungs for long periods. It’s crucial to their survival. Kim Gergelis, M.D., is working on a way to bring the same military-based training concept to breast cancer patients being treated with radiation at Wilmot Cancer Institute. Research shows that “deep breath holds” for 20 seconds moves the heart away from the breast temporarily, reducing the chances that high-energy X-rays aimed at breast tissue will inadvertently damage the heart.
Gergelis, who recently joined Wilmot from the “other” Rochester — the esteemed Mayo Clinic in Rochester, Minn. — has many fresh ideas like this one.
And, she arrived in upstate New York at a perfect time to make an impact. Wilmot’s growing and flourishing Comprehensive Breast Care program has an impressive list of new initiatives. These include groundbreaking clinical trials unique to this region; advanced technology not found anywhere else in the state to diagnose breast cancer; a popular new risk-reduction clinic that serves women with any type of breast concern; a retooled survivorship program for individuals who want to continue to be seen by breast cancer specialists long after they enter remission; new directions in laboratory research, and a mobile unit — “the mammo van” — that launches later this year to bring mammography screening to patients in urban and rural areas with less access to quality care.
“I interviewed all over when I was looking to take the next step in my career,” says Gergelis, assistant professor of Radiation Oncology. “I felt like the University of Rochester and Wilmot were trying to make things better. There are a lot of places that are okay with the status quo. Here, the leadership wants to see changes, learn things from the outside, and make improvements. That’s really exciting to me.”
“Collaborative Spirits” Drive Change
Breast cancer remains the number-one cancer in women nationally and locally, and since 2019, there’s been an uptick in breast cancer patients seen at various Wilmot sites, including its hub location, the Pluta Cancer Center in suburban Henrietta. Improvements in diagnosis and treatment of breast cancer are occurring rapidly in the field, but there are gaps in knowledge and in who gets quality care.
Wilmot leaders are building research into every facet of its breast cancer program, with the goal of becoming the premier center in New York state.
“Our mantra is, ‘enhancing clinical care, supporting and fostering research, and growing our team of highly academic oncologists,’” says Anna Weiss, M.D., the newly recruited director of Wilmot’s breast cancer service line, a surgeon who joined the UR in 2022 from Harvard University.
Research is the foundation for all new treatments, and Weiss’ other major objective, still unfolding, is enhancing connections between clinicians and lab scientists working on breast cancer across the Medical Center to build larger, cross-institutional research projects. Her kindred souls include Jennifer Harvey, M.D., chair of Imaging Sciences and an international expert in breast density, which leads to a higher risk of cancer, and Ruth O’Regan, M.D., chair of Medicine and a national thought leader in novel breast cancer treatments, focusing on what’s known as triple-negative disease, the most aggressive type of breast cancer.
They are working in unison.
“The beauty of Ruth, Jennifer and I, is our collaborative spirits,” Weiss says. “We’re excited about moving things forward. We have a lot of enthusiasm and energy, which is going to lead to more innovation.”
New Technology Improves Breast Cancer Diagnosis
To the surprise of many people, about 85% of breast cancers occur in patients with no family history. The biggest risk factors are simply being female and aging. But when detected early, most types of breast cancer are highly treatable and many are curable.
That’s why talking to a physician about personal risk and undergoing consistent screening are so important.
Mammography is the gold standard screening test, but it’s not perfect. It’s physically uncomfortable — which causes some women to avoid it — and for individuals who have dense breast tissue, the density makes it more difficult to see tumors. Dense breast tissue is white on a mammogram, making it harder to see cancers, which are also white. Radiologists describe this as “looking for a snowball in a snow storm.” More than 40 percent of women of screening age have dense breasts, particularly in their younger years.
However, Wilmot is one of the first locations in the United States and the first in New York to offer an advanced ultrasound device designed to improve tumor detection in dense breasts. The device boosted detection by 20 percent, compared to mammography alone, in nationwide clinical trials conducted for the U.S. Food and Drug Administration. The imaging technique also is more comfortable for the patient: No touch or squeezing required. A person lies face-down on a table with an opening for the breast, which is immersed in a warm water bath as it’s being scanned.
Called SoftVue 3D Whole Breast Ultrasound Tomography, it was co-invented by a Wilmot faculty member, Neb Duric, Ph.D., professor and vice chair of research for Imaging Sciences. (The technology is available for eligible individuals at the UR Medicine Breast Imaging Center, 500 Red Creek Drive.)
In a prior career as an astronomer and astrophysicist, Duric’s niche was image-processing of stars and galaxies — a field that is surprisingly useful and similar to improving image quality for human health.
“Breast imaging radiologists are very aware of the limitations of mammography in women with dense breasts,” says Avice O’Connell, M.D., director of women’s imaging at UR Medicine, who will work with Duric to further develop of the SoftVue system. “3D imaging is the wave of the future, and SoftVue ensures consistent and reliable images while offering a more comfortable patient experience. It is unmatched by any other imaging modality currently in the marketplace.”
For many reasons, though, it is not feasible for every woman with dense breasts to receive an ultrasound following a screening mammogram. Harvey, the chair of Imaging Sciences, is therefore studying new ways to discern who is most likely to develop a lump between mammograms, or to have a tumor hiding in that blurry “snow storm.”
“That’s been my lifelong passion,” Harvey says. “How do we do better in this regard?”
Breast Cancer Treatment Trends: Personalized and Precise
A decade ago, it was fairly common to treat most breast cancer patients with chemotherapy. Since then, research that focuses on overtreatment and molecular profiling of tumors has shown that many patients do not need chemo. The reasons are as complex as each individual — ushering in an era of truly personalized care.
“The less-is-more trend is most successful in low-risk estrogen-fueled cancers,” says O’Regan, who also serves as physician-in-chief at Strong Memorial Hospital at the University of Rochester Medical Center.
“Overall, research has prevented thousands upon thousands of patients with breast cancer from having to undergo chemo, and that’s a huge step forward,” O’Regan says. “The question now is: Are there more patients who don’t need chemotherapy at all, or who just need less chemotherapy?”
Thanks to O’Regan, Wilmot is one of only two places in the nation to enroll patients in a clinical study of a two-drug combination that sets up a direct hit on triple-negative cancer cells. Wilmot is also part of a larger national network of clinical trials, evaluating the effectiveness of the newest drugs for triple negative breast cancer. Those studies, led by Carla Falkson, M.D., involve collecting tissue samples from patients so that investigators can conduct correlative laboratory studies to understand why the drugs work or don’t work on TNBC.
Wilmot offers the latest treatments, including immune therapies for breast cancers that may have started to metastasize; targeted drugs known as PARP inhibitors for patients with the inherited BRCA gene mutation, a gene that greatly increases the risk of developing aggressive disease; and studies to discover if some patients with the HER2 gene signature can safely use a less-toxic precision drug.
“We’re very on top of things in terms of new therapies,” O’Regan says. “The idea is to move away from the standard chemotherapy and give patients only the treatment that they need — to find agents that are more effective but with less toxicity, especially for patients with metastatic disease because they will be on treatment indefinitely.”
The same treatment trends are occurring in radiation therapy.
For women who opt for breast-sparing surgery (lumpectomy), the standard care had been to follow up with six weeks of radiation treatment, five days a week. Later, research began to show that physicians could safely give slightly more radiation each day, and reduce the duration to three or four weeks. Today, some cases qualify for just a single week of radiation.
“Patients are shocked when they learn this,” says Gergelis. “It’s a pretty neat thing, to see where we’re evolving.” The treatments are biologically equivalent in terms of killing the cancer cells, but more convenient. Daily radiation is a burden, even though the treatment itself only takes a few minutes. It hampers work schedules, delays travel, and creates concern about injury to skin and nearby organs.
The evolution toward condensed radiation therapy, including partial versus whole breast irradiation, is often based on tumor type, age, lifestyle, and treatment goals. Wilmot has new clinical studies in this area.
Research allows physicians to be nimble, to design precision therapy.
“The whole point is to ‘right-size’ treatment for each person based on their circumstances,” Gergelis says. “To give all the treatment that’s needed and escalate it in the most aggressive cases, while customizing cancer treatment for those who have less aggressive disease.”
Breast Cancer Research at Wilmot
The median age for a breast cancer diagnosis is 62, according to the American Cancer Society. Wilmot is a national leader for treating older adults with cancer — no matter what type — and has a large portfolio of studies geared toward enhancing elder patient care by understanding the whole person and how cancer can impact functionality, memory, and family support.
Most recently, geriatric oncologist Allison Magnuson, D.O., a breast cancer specialist, started a novel project for older patients with pre-existing dementia. She was recently funded by a $2.5 million National Institute on Aging grant, to evaluate ways to improve communication between physicians and people with cognitive problems as they face breast cancer.
At the other end of the spectrum, several Wilmot scientists are investigating how breast cancer develops and spreads. Paula Vertino, Ph.D., the Wilmot Distinguished Professor in Cancer Genomics, is looking at breast cells with invasive potential and the underlying signals during the earliest steps in their migration toward metastasis. The goal is to reprogram cells to correct this aberrant behavior.
Another innovative project plunges into the root of cancer cells and how they behave — specifically, how breast cancer cells make their own antioxidants, which is their “food,” and then use the antioxidants to survive.
Isaac Harris, Ph.D., assistant professor of Biomedical Genetics and another recent Harvard University recruit, leads this research with advanced technologies and a thinking outside-the-norm strategic approach.
His scientific question: Is there something special about how cancer cells are feeding themselves? Is it different than normal tissue? He’s finding that antioxidants can be broken down into individual or groups of metabolites, essentially acting as storage facilities for tumor food.
Laboratory studies show that, generally, cancer cells need these metabolites to survive. Harris is trying to understand the process by which they obtain the metabolites. His developing views on how this occurs are different from other researchers. If his hypothesis is correct, the goal is to use currently available drugs to block the feeding of cancer cells.
“Our novel ideas,” he adds, “have been well-received in the scientific community.” In 2022, the National Cancer Institute funded Harris’ research with $1.9 million.