was previously approved by the FDA
for MRI of the central nervous system.
course would bene;t from the vaccine doses they received.
Moreover, a two-dose vaccine schedule could potentially
reduce costs and increase compliance, which would lead to
broader protection of the population.
Testing for HPV, together with the standard Pap test, was
;rst recommended as an alternative to the Pap test alone for
cervical cancer screening 10 years ago ( 82). It was recently
reported that an HPV test called the cobas HPV test, which
detects all currently identi;ed carcinogenic HPV strains,
identi;ed women at high risk for cervical cancer more
e;ectively than the Pap test alone ( 83). As a result, the FDA
approved the use of the cobas HPV test as a stand-alone
option for cervical cancer screening for women age 25
and older in April 2014. ;is provides women with a less
burdensome screening option and could potentially reduce
health care costs.
High-risk, High-reward Prevention
;e hormone estrogen fuels the growth and survival of
about 70 percent of breast cancers. It does this by attaching
to speci;c proteins called hormone receptors in and on the
breast cancer cells. ;is knowledge led to the development of
antiestrogen therapeutics more than three decades ago, and
these medicines are the mainstay of treatment for patients
diagnosed with hormone receptor–positive breast cancer.
Two antiestrogen therapeutics, tamoxifen (Nolvadex)
and raloxifene (Evista), are approved by the FDA for the
prevention of breast cancer in women at high risk for
developing the disease. However, their use in this setting
is not widespread, in part, because tamoxifen increases the
risk for endometrial cancer, and both therapeutics may
increase risk for blood clots and stroke.
In December 2013, results of a large-scale clinical trial
showed that another antiestrogen therapeutic, anastrozole
(Arimidex), more than halved breast cancer development
among postmenopausal women at high risk for developing
the disease, with very few side e;ects ( 84). ;us, anastrozole
may, in the future, provide a new cancer prevention option
for women at high risk for breast cancer, such as those at
high risk for inherited forms of the disease (see sidebar
on How Do I Know If I Am at High Risk for Developing an
Inherited Cancer?, p. 30).
A Clearer Picture of Breast Cancer
Most women who receive a breast cancer diagnosis a;er a
mammogram are referred for further testing to assess more
precisely the size of the breast tumor and to determine
whether the cancer has invaded local tissue or spread to other
parts of the body. ;e results of these tests are important for
providing the patient with an accurate diagnosis, which is
crucial for deciding on the best course of treatment.
For some women, one of these follow-up tests is magnetic
resonance imaging (MRI) of the breasts to establish
the extent of the tumor within the breasts. MRI of the
breasts can also be used to evaluate abnormalities seen by
mammogram that were insu;ciently clear for physicians
to determine whether the patient has breast cancer or how
large the tumor is.
In some cases, patients undergoing an MRI of the breasts
are injected with a liquid called a contrast agent to help
visualize abnormalities more clearly. In June 2014, the FDA
approved a new contrast agent to use with MRI to assess
the presence and extent of cancer within the breasts. ;is
decision was made a;er the results of two large clinical
trials showed that the new contrast agent, gadobutrol
(Gadavist), signi;cantly improved the ability of MRI to
clearly visualize cancer in the breast.
Treatment With Molecularly Targeted
Research is continually expanding our understanding of
cancer biology. ;is knowledge is allowing us to treat cancer
by targeting speci;c molecules involved in di;erent stages
of the cancer process. As a result, the standard of cancer
care is changing from a one-size-;ts-all approach to one in
which the molecular makeup of the patient and his or her
tumor dictates the best therapeutic strategy. ;is approach,
variously called personalized cancer medicine, molecularly
based medicine, precision medicine, or tailored therapy,
is already transforming lives and will undoubtedly bene;t
many more patients in the future.
As a result of the greater precision of molecularly targeted
therapeutics, they are more e;ective and tend to be less
toxic than the treatments that have been the mainstay of
patient care for decades. ;us, these new medicines are not
only saving the lives of countless cancer patients but also
improving their quality of life.
Molecularly Targeting Blood Cancers
Cancers that begin in blood-forming tissues, such as the bone
marrow, or in cells of the immune system are called hematologic
cancers or blood cancers. ;ree very recent FDA decisions have
provided new treatment options for some patients with two
types of hematologic cancer, chronic lymphocytic leukemia
(CLL) and mantle cell lymphoma (MCL) (see sidebar on Recent
Advances Against Blood Cancers, p. 53).