October is Breast Cancer Awareness Month.
Around 1 in 5 breast cancers are HER2-positive. HER2-positive cancers are a type of breast cancer that contains higher-than-normal levels of HER2 proteins, which help cancer cells grow and multiply. HER2-positive cancers can spread quickly, but they also have one of the highest survival rates when diagnosed early, thanks to highly effective treatments that specifically target HER2 proteins.
Understanding how HER2 status is diagnosed and treated can help you advocate for yourself and make informed decisions as a crucial member of your medical team.
We asked Roshani Patel, M.D., FACS, medical director of the breast program at Jersey Shore University Medical Center and member of HealthyWomen Women’s Health Advisory Council, what women should know about HER2-positive breast cancer.
What is HER2-positive breast cancer?
HER2-positive breast cancer cells have parts that I like to describe as “antennae,” which send messages to the cancer cells telling them to divide quickly. That makes this type of cancer aggressive, and that’s bad news. The good news is that your medical team can block the signal that’s sent from the antennae. The medicine we use to fight HER2-positive cancer is very effective because we have these parts that we can target — especially if we can treat the cancer early, before it spreads.
What are the risk factors?
Risk factors for HER2-positive breast cancer are the same as they are for all types of breast cancer. Family history plays a role: having a first-degree relative (a mother, sister or daughter) with breast cancer doubles your risk. Eating an unhealthy diet and obesity play a role. Metabolic syndrome also contributes to your breast cancer risk. Metabolic syndrome is a combination of at least three of five health issues: low HDL — or “good” — cholesterol, high triglycerides, high fasting blood sugar, high blood pressure and having fat around the stomach.
How is HER2-positive breast cancer diagnosed?
HER2-positive breast cancer is diagnosed through a biopsy. A radiologist or surgeon will take a sample of the tumor. The sample goes to a pathologist and special dyes are used to identify targets on the cells.
What are brain metastases and leptomeningeal spread in HER2-positive breast cancer?
When HER2-positive breast cancer spreads, it is one of the most likely breast cancers to spread to the brain and the leptomeninges. Think of the leptomeninges as a bed sheet that acts like a thin cover around your brain and spinal cord.
Why do HER2-positive breast cancers have a higher risk of brain metastases and leptomeningeal spread?
HER2-positive cancer cells can spread through the blood-brain barrier. The blood-brain barrier keeps your brain out of harm’s way from things like germs, viruses and bacteria, but some cells can get through. HER2-positive cancer cells can spread through the blood-brain barrier because they have substances that make them stickier. Also, some cells act like chameleons or shape-shifters and can change so they can pass through.
What treatments are used for HER2-positive breast cancer?
HER2-positive cancer is treated with surgery, chemotherapy and targeted antibody treatments. Monoclonal antibodies like trastuzumab target the HER2 proteins to stop them from multiplying and signal the immune system to fight the cancer. More antibody treatments have been developed and are rapidly evolving. These drugs can effectively enlist the body’s natural immune system to fight cancer. Treatments have gotten so effective that survival rates for stage 1 are over 90%. The rate for stage 2 survival is 85–90% and even at stage 3, survival is above 80%.
This educational resource was created with support from Merck and Daiichi.
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