"Oh, The Changes I’ve Seen" - Op Ed by Bob Riter

I was diagnosed with breast cancer thirty years ago and I’ve attended dozens of national cancer research conferences since then. It’s a useful exercise to step back from time to time and look at the big picture. What’s changed in our understanding of cancer and cancer treatment in those three decades? (Note that this article isn’t specific to male breast cancer). Here are some of the broad themes-

Targeted Therapies: Thirty years ago, chemotherapy used a shotgun approach. Shoot and hope for the best. It wasn’t generally clear who would benefit from chemotherapy, so we gave it to most people, hoping that those who could benefit from it would benefit, and those that didn’t benefit weren’t terribly damaged by it.

Today, we’re much better able to match the drug(s) to the biology of the specific tumor. In the first national conference that I attended - the San Antonio Breast Cancer Symposium - Dr. Dennis Slamon presented the results of a trial of trastuzumab (Herceptin) which proved to be remarkably effective in the treatment of Triple Negative Breast Cancers. This was one of the first targeted cancer treatments.

Targeted treatments are wonderful because the individuals with that biological target are likely to benefit. Equally important is an understanding of who won’t benefit from that treatment.

Deescalation of Treatment: We’ve slowly evolved from thinking that the most aggressive cancer treatment is always the best cancer treatment. I’ve seen this in the surgical removal of axillary lymph nodes. Thirty years ago, it was common to have a complete axillary dissection as a routine part of any mastectomy or lumpectomy. A few years later, sentinel lymph node dissection became the standard of care and additional nodes were removed only if the sentinel nodes were positive. More recently, it’s been discovered that removing a small number of positive nodes does not provide additional benefit and a complete axillary dissection is only performed if there’s extensive axillary involvement. We increasingly realize that less treatment is often better treatment.

The Tumor Microenvironment: For most of history, our research focus has been on the biology of the cancer tumor. Over the past decade or so, we’re increasingly aware of the importance of what surrounds the tumor. (This is often referred to as the tumor microenvironment). That environment impacts the ability of the tumor to spread, and also affects the ability of drugs to reach the tumor. Immunotherapy has been one of the most important advances in cancer therapy for the past couple of decades, and it specifically activates and deactivates immune cells in that microenvironment.

Cancer as an Evolutionary Process: Finally, we’re increasingly thinking of cancer in evolutionary terms. Cancer cells constantly multiply and only the “fittest” cancer cells manage to take root in other organs. Further, while cancer treatments generally kill most cancer cells, the cancer cells that remain are - by definition - the most resistant to treatment, and those cells are the ones that continue to multiply. In the future, treatments may be designed with evolution in mind. Some cancers might be better controlled not by attempting to kill every cancer cell, but by “managing” the populations of cancer cells that are sensitive and those that are resistant to treatment.

Our knowledge of cancer continues to evolve. Had I been diagnosed today instead of in 1996, my treatment would have been quite different. I would have had a sentinel node biopsy (instead of a complete axillary dissection), and I likely would not have had chemotherapy given my tumor biology. But that’s the nature of science. We know more and treatments will continue to improve and be more personalized to each individual. I’m excited to see the changes that will take place in the next thirty years.

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Advancing Research. Empowering Advocates:

Changing the Future of Male Breast Cancer.

The Male Breast Cancer Global Alliance (MBCGA) Research Committee is where science, patient advocacy, and collaboration come together to accelerate progress against male breast cancer. Committed to evidence-based decision-making, the committee serves as a trusted voice in evaluating emerging research, supporting promising scientific initiatives, and ensuring that the unique needs of men with breast cancer are represented throughout the research process.

Committee members work alongside leading investigators, pharmaceutical trial teams, clinicians, and advocacy organizations to review research proposals, contribute valuable patient perspectives, promote educational programs, and mentor the next generation of research advocates. The committee also helps ensure that MBCGA educational resources remain aligned with the latest scientific evidence while encouraging greater participation in nationally recognized advocacy training programs.

Whether you are a survivor, caregiver, healthcare professional, or advocate passionate about advancing research, the MBCGA Research Committee offers a meaningful opportunity to make a lasting impact. By connecting lived experience with scientific discovery, the committee is helping shape better treatments, stronger collaborations, and a brighter future for every man affected by breast cancer. Together, we can transform advocacy into action and research into hope.

Bob Riter

My organizational connections:

• Advocates for Collaborative Education (ACE) (Communications Chair)
• Susan G. Komen Advocates in Science (Steering Committee)
• Male Breast Cancer Global Alliance (Advocate Research Committee)

Writings:

• Books by Bob Riter
• "Making the most of cancer: My journey from diagnosis to advocate" (An essay on the Living Beyond Breast Cancer website).
• The Bridge Builder (from Cancer Today)