This article is brought to you by: Breastlink visit www.breastlink.com for more information This year marks 20 years Breastlink has helped patients with their breast health needs. As I reflect back upon our history I have never felt more stronglythat our comprehensive, multidisciplinary approach to treat breast cancer best serves women. I also believe, thanks to clinical research, we are on the cusp of discovering a real cure for many types of breast cancer in the next decade. Research hasbegun to reveal the genomic differences in cancer cells. This will lead to new, “targeted” agents that will significantly improve treatment options.Breastlink, through our work with the Cancer Research Collaboration , is involved in many of thepromising clinical trials. However, the reality persists that far too many women succumb to this truly horrible malady. Before we look to the future, I have outlined the history andprogress of our practice. History of Breastlink In the 1970s, attitudes toward breast cancer treatment began to change for the better. Radical mastectomy had been the preferred method for treating breastcancer since the late 19 th century. This procedure called for the complete removal of all breast tissue, the nipple, lymph nodes in the armpit,and muscles lining the chest wall beneath the breast. During this time, women were rarely consulted about treatment. Some even awoke from sedation to find that the decision to remove their breasts had alreadybeen made for them. The move toward a more individualized treatment approach was welcome. It became increasingly apparent that there were equally effective, morepatient-friendly alternatives to radical mastectomy. As this occurred, more women refused the one-size-fits-all breast cancer treatment. In 1979, the National Institutes of Health issued a statement declaring that surgery to treat breast cancer should preserve as much muscle tissue aspossible. They also indicated radiation therapy could be administered as a primary treatment with limited surgery. More importantly, the consensus statement recognized that a preoperative needle biopsy should be performed “before definitive therapeutic alternatives arediscussed with the patient.”Physicians were finally beginning to realize that women should have a say in their treatment. Inspired by the voices of women calling for a greater role in their treatment, as well as growing enthusiasm for the development of new and better ways toprevent, I helped to found one of the nation’s first comprehensive breast cancer treatment centers in 1985. Helping to develop the breast cancer treatment center at the Long Beach Medical Center was an invaluable experience that would inform my decision-makingwhen I set out to establish Breastlink. Founded in 1995 as a single, outpatient facility in Long Beach, Breastlink has grown into a network of three outpatient breast cancer treatment centers.These centers offer women a multidisciplinary medical team and comprehensive services aimed at breast cancer screening, diagnosis, treatment and follow-up. A Comprehensive Breast Cancer Care Model Since breast cancer treatment paradigms began to shift in the 1970s, it has become apparent that a multidisciplinary approach to breast cancer offers women the most optimal care available. A comprehensive breast cancer care model provides access to a coordinated team of multiple physicians practicing across different specialties. Using thismodel, a woman can have all of her breast cancer screening or treatment needs attended to by a single team working under the same roof. As medicine has become increasingly specialized and new knowledge revealed how individual cancers behave differently, more and more types of physicians areincluded in breast cancer treatment. A breast cancer treatment team should include at least four or five different specialists, including: Radiologists Pathologists Surgeons Medical Oncologists Radiation Oncologists Psychotherapists Most physicians are inclined to practice what they know. For instance, a surgeon will most likely be inclined to believe that surgery is the best availabletreatment option. This is partly why radical mastectomy remained the standard of care for so long. However, a multidisciplinary team working together can help physicians to look past professional biases. When we work together with each other andpatients, the result is more appropriate treatment. A comprehensive breast health care treatment model works most effectively when women are placed in a partnership with their physicians. The goal is toprovide individualized care that is neither over-nor under-treated. Treatment should offer the best chance for survival with as few side effects aspossible. Physicians can optimize treatment outcomes by offering a combination of education, compassion, communication and experience. Providing comprehensive breast cancer treatment means treating the whole woman, not necessarily just the disease. Treatment must be compatible with women’sown beliefs and philosophies. Breastlink helps to accomplish this by providing numerous resources under one roof. This includes physicians, nurses, researchers, medical assistants, psychotherapists and nutritionists. Each member of this treatment team, those seen andunseen, contribute to healing as defined by the woman being treated. Looking Toward the Future of Targeted Therapies Breast cancer is the result of gene mutations. Some mutations cause cells to achieve additional function, allowing them to grow out of control, or tobecome drug resistant and to spread to other parts of the body. Other mutations can cause cells to lose their function, which creates susceptibility tocancer. Not all breast cancers are created equal. The underlying gene mutation that allowed cancer to begin growing will also dictate how that cancer behaves as itgrows. Growing knowledge of the relationship between gene mutations and breast cancers has led to the potential for evermore individualized treatments. Forinstance, in approximately 20 percent of cancers, a protein known as HER2 is present on the surface of cancerous cells. When this protein is present, cancers tend to grow especially quickly and aggressively. To combat HER2-positive cancers, researchers and pharmaceutical makers have investigated drugs that specifically target this protein. Herceptin, introducedin the late 1980s, was one of the first of these targeted drugs to be developed. Herceptin can attach itself to HER2 proteins to slow cancer growth andpromote chemotherapy response. We now have a number of anti-HER2 agents that target this type of breast cancer. Herceptin is just one example of many targeted therapies, either on the market or being investigated. Targeted therapies are designed to attack a specificgenetic mutation of the breast cancer. It is important for women to learn about their individual cancer, as well as emerging treatment options and targeted therapies, to make an informed decision about treatment . Breastlink has been proud to participate inthe research into these targeted therapies and to maintain up-to-date knowledge of ongoing research. This allows us to provide women the information theyneed to make a decision customized to their priorities and their disease. Many gains have been made in our understanding of breast cancer over the past twenty years. Women have benefitted from advancements in prevention,screening and treatment. Research exploring new treatments and interventions show potential for continued improvement in breast health care. A big part of what we do is clinical research. Over the next few years, we will expand our participation in research to help women have access to orreceive therapies still under investigation. Breastlink has worked with researchers for many years to improve access for patients to new drugs or therapies currently under investigation. Through apartnership with Cancer Research Collaboration , a non-profit organization, we are able to continue tooffer our patients a robust opportunity to participate in the development of new agents and new tests. This also provides researchers access to a team of clinical investigators with strong research backgrounds who can help to identify breast cancer patients that are qualified candidatesfor research projects. We believe partnerships such as these can improve process for delivery and approval of effective cancer therapies, and add to ourcollective knowledge of cancer. We strive for a future without breast cancer research moves us closer to this future. I wish to thank my co-workers, colleagues, the community and, most of all, our patients for their support. Without you all Breastlinkwould not be possible. We look forward to working with you over the next 20 years and beyond to improve breast cancer care. About Breastlink and Dr. John Link John Link, MD is the founder of Breastlink and a leading medical oncologist dedicated to the care of women with breast cancer. To learn more about Dr. Linkand Breastlink please visit Breastlink.com .