Stepping Up

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Asli Goncer’s breast cancer diagnosis in 2018 left the software developer with the challenge of her life. But she set about to overcome the disease with an engineer’s mindset. Step by step. Day by day.

She set up a ride system with her friends. She strictly followed her Orlando Health doctor’s instructions. She arranged with the federal agency she works for to make up days she missed because of treatment and other complications.

“It’s not a fun thing to go through,” says Goncer, who is 56 and blind. “But I never felt like, ‘Oh, I’m going to die.’ I just felt like I have a lot of work to do.”

The approach helped her get through a double mastectomy in December 2018, followed by chemotherapy from January through July of 2019 and an all-clear diagnosis later that year. But with stage 3C cancer, Goncer faced a risk of a recurrence, and upon the advice of her doctor enrolled in a clinical trial.

The Phase 3 study involved adding the drug ribociclib to standard hormone therapy. Hormone treatment, also known as endocrine therapy, is a mainstay treatment for estrogen-receptor positive breast cancer, which represents roughly 70% of breast cancers in women. It helps to slow or halt the growth of tumors by blocking the body’s ability to produce hormones or interfering with hormones’ effects on breast cancer cells. Ribociclib, which also goes by the brand name Kisqali, works by blocking the activity of two enzymes that control cell division and preventing cancer cells from replicating.

Nikita Shah, the Orlando Health physician who treated Goncer, says results of the study are promising — and that adding ribociclib to endocrine therapy reduced the risk of a disease recurrence by 25%. That’s a big win, Shah says. “In oncology, we get excited with a 5-10% increase.”

While Shah clarifies that metastatic diseases are still not curable, she says research has gone into ensuring people live longer after being diagnosed. “There is a lot of progress compared to where we were a decade ago,” she says.

And she credits patients such as Goncer with making advances in cancer treatment possible. Recent studies suggest that fewer than 10% of adult patients with cancer participate in oncology treatment trials, which are a critical step toward new treatments. “Unless we do trials and research, we cannot get there,” she says. “Hundreds of thousands of participants have given us information. They are the ones who advance cancer research.”

Screening Trends

More than 20% of women between the ages of 50 and 74 are not meeting the recommended screening guidelines for breast cancer. The American Cancer Society recommends that women with an average risk of breast cancer between the ages of 45 and 54 get a mammogram every year. Women 55 and older can switch to a mammogram every other year or continue to get yearly mammograms. Women at a high risk of breast cancer — based on factors such as a family history, genetic mutations, a history of chest radiation or certain other medical conditions — should get a breast MRI and mammogram every year, typically starting at age 30.

Tags: Healthcare, Feature, Economic Backbone: Breast Cancer