A new blood test could be the key to earlier detection of breast cancer

Chemotherapy has become synonymous with the word cancer.

“The best way I can explain it is like if you swallowed a hand grenade and now it's going to explode inside out. But then no. Chemotherapy is just horrible,” said Dr. Leela Ghaffari as she talked about her recent treatment journey.

It's cruel, but often necessary. When used alongside other therapies, it has provided longer, recurrence-free survival to a growing number of cancer patients.

“If you want to live, you have no choice, right?” Ghaffari said. “You know, you don't have a choice.”

Ghaffari was diagnosed with breast cancer for the second time last November. She underwent sixteen sessions of chemotherapy so doctors could shrink and then safely remove her clementine-sized tumor.

Once she completed the radiation sessions, her treatment was generally considered complete.

“They always ask, 'What now? Are you sure? What can you do? What can you do to be sure?'” says Dr. Massimo Cristofanilli, director of breast medical oncology at NewYork-Presbyterian/Weill Cornell Medicine.

Cristofanilli said the lingering doubts are evidence of the need for better monitoring tools for cancer patients, who, like Ghaffari, have just completed a harrowing course of treatment.

“There used to be no standard to monitor this. Women have done the treatment, come for their clinical follow-up and there is no imaging,” Cristofanilli said.

Traditionally, an imaging scan is ordered three months after the end of the main treatment. Thanks to Cristofanilli's work, there is now a new way to more quickly check whether cancer returns.

It is called a liquid biopsy, performed based on a simple blood draw. The sample is placed in a machine that looks for traces of cancer cells. The latest technology can localize the DNA of those tumors. The more cells detected, the more advanced the disease.

“If a tumor is active somewhere in your body and is releasing DNA, we can capture it,” says Dr. Nancy Chan, director of breast cancer clinical research at NYU Langone Health. There, doctors use liquid biopsies in clinical trials to find more targeted and less invasive treatments for patients.

“The test is available. We need to figure out the best way to use it for the benefit of breast cancer,” Chan said.

So far, studies show that liquid biopsies can accurately identify lung cancer and breast cancer recurrences.

“I can't tell you how tragic it is, because you think you're done,” Ghaffari said. “And now you suddenly realize that we're not done yet, you know. And it wouldn't have been discovered if I hadn't had the blood test.”

That could be the silver lining to news of a cancer return. A PET scan confirmed what the liquid biopsy discovered: Ghaffari had a small, slow-growing tumor.

“I think it's less than 1 centimeter. It's very small. If we can catch it at that level, imagine how quickly they can step in and stop it,” Ghaffari said.

With new targeted precision therapies, many with late-stage cancer survive for years after treatment, and many early-stage cancers are considered cured.

“Of course we do imaging more often in metastatic diseases, but thanks to this blood test we can intervene even earlier than we did in the past,” says Cristofanilli. “So all in all, new drugs and the ability to implement the right drug has certainly increased our ability to keep women not only alive but functional, without having to undergo very difficult and obviously toxic treatment.”

Now Cristofanilli and his team are trying to answer the question: Can the liquid biopsy test be used to detect cases of breast cancer earlier, for the first time? Weill Cornell is currently recruiting women with no history of breast cancer to receive liquid biopsies in addition to their annual mammograms.

“Once we know and can be confident that it is not a false positive, but just a positive result before imaging, we can design an intervention, so it is very exciting for the future,” Cristofanilli said.

He said the hope is that the liquid biopsy will become for breast and other cancers what the A-1-C test is for diabetes.

“We can certainly say that the majority of cases would be in the first phase or even less, undetectable and need to be prevented. So this is called cancer interception,” he said.

“That's really our goal. And, most importantly, improve the quality of life. This way we can keep the disease under control for longer. They can use these drugs for longer without the toxicity of standard chemotherapy,” Chan said.

For Ghaffari, early detection means no additional chemotherapy. Still, the drugs that target her new tumor come with their own uncomfortable side effects. She works with Cristofanilli to adjust the dosage.

Ghaffari said she continues to fight through it as she plans to practice dentistry again and hopes to celebrate her son's upcoming wedding in style.

“I hope my body is back to normal. My hair is back to normal. You know, it's coming back,” Ghaffari said. “I want to have quality of life. And these types of tests are certainly helpful so that people can have quality of life if they catch it early, you know, or in my case adjust the medication to make it viable.

Spectrum News NY1 and News 12 are teaming up for a Breast Cancer Awareness Month program that will air Monday, October 30 at 9 p.m. The special highlights groundbreaking research taking place in the Tri-State area and underlines the importance of breast cancer prevention and detection.