Over 200,000 new cases of breast cancer are diagnosed in the U.S. annually, according to the National Cancer Institute. Dr. Anita Aggarwal, an oncologist at the Washington, DC VAMC, recently completed an extensive study to compare male and female breast cancer in VA patients. The study found that males with breast cancer had higher stage and grade at presentation and higher mortality compared with females. But, when adjusted for age, stage, and grade, males had better survival rates.
Federal Practitioner talked with Dr. Aggarwal about the new breast cancer research group she is currently developing at the Washington, DC VAMC. Dr. Aggarwal’s hope is to help doctors in the federal health system to identify etiology, biology, and improve treatment of both male and female patients with breast cancer.
Federal Practitioner: What is a breast cancer research group, and why do you think one needs to be created at the VA?
Anita Aggarwal, MD: I would like to build a breast cancer research group with the help of all oncologists and health professionals who take care of patients with breast cancer at all VAMCs nationwide. From my retrospective comparison study, breast cancer in our veterans seems to be different than in the general population. The goal of this research group will be to build a data bank with all the pertinent information as well as tissue gene profiling. This will help us to diagnose them early and treat accordingly in a timely fashion.
FP: As more women join the military, do you think breast cancer treatment at the VA will change?
AA: As the number of female veterans increases, I suspect we will see an increase in the number of female patients with breast cancer. As reported by the 2012 Women’s Task Force, women are now the fastest growing cohort within the veteran community. In 2011, there were about 1.8 million women veterans, which is about 8% of the 22.2 million vets in the VA system. That is expected to increase to 2 million in 2020, at which time women will make up to 10.7% of the total vet population. To accommodate these changing needs, the VHA made women’s health programs a priority in 2007, including a recommendation to improve access to screening, mammograms, and related breast care services. The treatment of breast cancer is becoming more personalized with the advent of new, targeted therapies. The treatment will change if we can identify different biological targets in veterans with breast cancer.
FP: Do you think all veterans, male and female, are more susceptible to breast cancer than is the general population?
AA: In general, incidence of breast cancer is decreasing but, as per the Walter Reed General Hospital and USA Today, breast cancer is one of the most common cancers in our veterans. Not only is the number of women with breast cancer increasing, but so too is the number of male veterans with breast cancer. In general, breast cancer in males is rare, < 1% of all breast cancer cases. Our retrospective data from 1995 to 2012 had more than 6,000 patients with breast cancer; out of that, 1,100 were males with breast cancer.
FP: What do you think needs to be changed about how breast cancer is approached in veterans?
AA: I don’t have an answer to that, but if we can build a breast cancer research group, we may be able to answer some of these questions. Collection of the data prospectively on all of breast cancer at all VA facilities will help us to understand etiology, risk factors, and biology by molecular profiling. In turn, this will help health professionals to give personalized treatment to veterans.
Read more about Dr. Aggarwal’s breast cancer initiative: http://www.research.va.gov/currents/spring2014/spring2014-45.cfm