his year, an estimated 178,000 women will hear their doctors say “You have breast cancer.” More than 40,000 women will die from the disease.

As October marks Breast Cancer Awareness Month, here are some of the hot topics in breast cancer research and patient care from the University of Michigan Comprehensive Cancer Center:

Pregnancy after breast cancer
Once Alyssa Tushman knew her young son would not grow up motherless, her next question was whether he would be an only child.

Tushman was 27 and a new mother when she was diagnosed with stage III breast cancer. After aggressive treatment – including chemotherapy, radiation therapy, a double mastectomy and reconstructive surgery – Tushman was happy to learn that another baby would be possible. And today, she’s pregnant with her third child.

Most women are in their 50s or older and thinking about grandchildren when they are diagnosed with breast cancer. But what about that increasing number of women in their 20s and 30s who are diagnosed at a point when they are dating, getting married and just starting their family?

Despite toxic chemotherapy regimens that can mess with ovarian function, it is possible – and safe – for many women to conceive after breast cancer treatment, U-M specialists say.

Disparities in breast cancer treatment
Black women, women with less education, women with lower household incomes and obese women may be receiving inferior breast cancer care. A series of studies have shown black women and women with less education are more likely to receive a nonstandard form of chemotherapy to treat their breast cancer. In addition, patients with a lower household income and less education are more likely to receive reduced doses of chemotherapy, as are severely obese women compared to lean women. Doctors calculate chemotherapy doses for each patient based on her height and weight.

“These study results suggest systemic differences in care stemming from factors that have nothing to do with the patient’s cancer. Given other disparities in quality of care and persistent outcome disparities in breast cancer among black women and women of lower socioeconomic status, our studies suggest the need to identify opportunities to address and eliminate these disparities,” says lead study author Jennifer Griggs, M.D., associate professor of internal medicine at the University of Michigan Medical School and a breast cancer specialist at the U-M Comprehensive Cancer Center.

‘Every day I’m killing cancer’
Heather Jose was 26 when she was diagnosed with advanced breast cancer. Told by her doctor to “get her affairs in order,” Jose promptly found a new doctor at U-M, one who was willing to help her fight. That was eight years ago. Today, Jose, 34, works to bring a message of empowerment and hope to other women with breast cancer while helping their doctors and nurses understand how important it is to engage their patients.

“As a patient, it’s our responsibility to be involved in our treatment. My mantra is: Every day I’m killing cancer. I don’t care if you kill cancer by eating well or by praying or doing yoga, you have to have that mindset that what I’m doing today is making a difference,” Jose says.

Patients more satisfied with specialized surgeons
Women with breast cancer who were treated by surgeons who specialize in breast cancer were more likely to be satisfied with their treatment experience. Specifically, these patients reported greater satisfaction with the treatment decision-making process and with their relationship with their surgeon, according to U-M Cancer Center researchers.

The researchers looked at patient satisfaction with the type of treatment they received, the process in which that treatment choice was made, the surgeon-patient relationship and the surgeon-patient communication.

Women treated by surgeons who devoted more than 60 percent of their practice to breast disease were more likely to be satisfied with the decision-making process compared to women treated by surgeons who devoted less than 30 percent of their practice specifically to breast disease. In addition, women with a specialized surgeon were more likely to say they were satisfied with their relationship with their surgeon.

Genetics and breast cancer
The genes BRCA1 and BRCA2 have been linked to breast cancer for some time. But it doesn’t stop there. Researchers at the U-M Cancer Center are identifying additional genes that seem to play a role in breast cancer. Studies of breast cancer tissue samples and cell lines found that the protein expressed by the CHFR gene was missing in many breast cancer cells. Further, when the protein was not expressed, tumors tended to be larger. When researchers turned off the expression of this gene in non-cancerous breast tissue cells the cells began behaving like cancer cells, suggesting that this gene is important in the development of some breast cancers.

In another study, researchers looked at SEPT9, a gene previously implicated in cell division and cancer. One unique form of this gene, SEPT9_v1, was found to be highly expressed in many breast cancer tissue samples and cell lines. When non-cancerous breast tissue cells were engineered to express this SEPT9 variant, the cells acted much like breast cancer. At the same time, when researchers took breast cancer cells and knocked out the expression of this gene, the cells became more normal in their behavior.

“We are very excited about these results and are engaged in ongoing studies to further understand how expression of these gene variants may correlate with prognosis and response to treatment,” says Elizabeth Petty, M.D., professor of internal medicine and human genetics at the U-M Medical School.