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MARY LOUISE KELLY, HOST:

It's WEEKENDS on ALL THINGS CONSIDERED. I'm Mary Louise Kelly, in for Guy Raz.

And we begin today with a story of a family. Meet the Grants.

TRACY GRANT: My name is Tracy Grant, and I live in New York City - Harlem, to be exact. I'm 48 years old, and I am a breast cancer survivor.

KELLY: Tracy was just 39 when she got the diagnosis.

GRANT: They asked me stay a little bit longer because they saw something a little weird. And in my mind, I was saying, here we go. This doesn't look good.

KELLY: As devastating as the news was, it wasn't a surprise. That's because of her family history. Meet Tracy's mom.

CATHERINE GRANT: I'm Catherine Grant. I'm 74 years old. I'm a native Washingtonian, and I'm a breast cancer survivor twice. The first diagnosis was age 51. That seems to be a magic number for us. It's always in the 50s.

KELLY: By us, Catherine means most of the women in her family. Her mother had it, three of her sisters, her daughter Tracy - three generations of Grant women. Catherine says the whole family works to try to break that pattern.

GRANT: We do the walks. We give. We're just waiting, hopefully, that something will come. And then sometimes I hear people say, but there's so much money that's given all the time, why can't they find a cure? And I said, I have no idea.

(SOUNDBITE OF MUSIC)

KELLY: It's an honest question, and it's our cover story today: How far have we come, and where are we headed in the search for a cure to breast cancer?

(SOUNDBITE OF MUSIC)

KELLY: The last few years have brought advances in the treatment of breast cancer. They have also brought confusion. New federal recommendations have left many women unsure when they should start getting screened and what options they have if cancer is diagnosed. We reached out to Dr. Larry Norton. He's deputy physician and chief for breast cancer programs at Memorial Sloan-Kettering Cancer Center. And I asked, in his view, when should a woman start getting mammograms?

DR. LARRY NORTON: If your goal is to reduce your odds of dying of breast cancer and to reduce your odds of needing a mastectomy, if that is your goal, then an annual mammogram starting at age 40 for your average risk woman is the best way to go.

KELLY: There's also, I think, a lot of confusion among women who receive a diagnosis over mastectomy, whether to have one. How much that may improve your rate of survival? What advice would you give?

NORTON: For a patient who's a candidate for breast conservation, mastectomy does not improve the cure rate, so that there are good reasons why somebody may choose mastectomy. But for most women with small tumors, improving the chance of cure is not one of those reasons. Of course, this has to be individualized.

There are medical reasons why mastectomy is a good idea - having more than one tumor in the breast, for example. A very large tumor in a relatively small breast is an example and so on. Sometimes we find pre-cancerous changes in the breast, and that's not true cancer, but doing a mastectomy removes those pre-cancerous changes so we can prevent those cells from turning into cancer. So there are good reasons.

But for most people who are diagnosed with cancer, especially those with smaller tumors, breast conservation is exactly the same cure rates as doing a mastectomy. And therefore, going to mastectomy is not going to be beneficial in terms of cure for that individual.

KELLY: Let me press you on innovations in care, in treatment once the breast cancer is diagnosed. I mean, for years, it has been mastectomy or aggressive chemical treatment, chemotherapy, et cetera. What specifically has changed in terms of - once breast cancer is diagnosed, what treatment options are out there?

NORTON: It's a whole package of approach that really works.

KELLY: OK.

NORTON: You need better surgery so that you know you've gotten the mass of tumor cells out. You need better radiation so that you are killing any cancer cells that are in the regional area completely with minimal toxicity to the patient, and you need better drug therapy, which can be hormones alone for certain individuals, and we could tell this by looking at the biology of the cancer.

It can be chemotherapy, which is much less toxic than it ever was before because we can eliminate things like low-blood counts, and we can eliminate nausea and vomiting in most cases. But we're also looking at new therapies such as immune stimulation, making the cancer itself, stimulate the immune system and unleashing the blockade that your cells may have, your immune cells may have, so that they don't attack your own tissues. We could release that blockade. So that there are a lot of very exciting things that are moving forward, and it's all based on a new understanding of the biology of cancer.

KELLY: Dr. Larry Norton of the Memorial Sloan-Kettering Cancer Center in New York.

So that's a quick update on treatments. But what about a cure? Dr. Barron Lerner is an internist and medical historian at Columbia University. His book is called "The Breast Cancer Wars." He says the idea of a cure means different things to different people.

DR. BARRON LERNER: There's certainly the individual cure of a patient. So someone who gets the disease gets treated successfully and is cured. And then there's the larger issue of almost eradication of a disease or getting rid of it from the environment, and that's obviously the much more challenging goal. It's happened in a couple of cases: the disease that people always talk about is smallpox, where it used to exist all over the place and then eventually it disappeared, but it's much, much harder with other diseases.

KELLY: When we talk about breast cancer, where does the effort - where does the search for a cure stand?

LERNER: People are talking about two types of things, I think, broadly. One is maybe a cancer vaccine, a breast cancer vaccine, to prevent the disease, or cleaning up the environment and removing environmental toxins that are probably linked to the incidence of breast cancer.

KELLY: Depending on what may have been the cause for an individual case of breast cancer, does that change the way you would want to treat it?

LERNER: You're pushing right in the right direction, because what we're learning now, since there are different types of breast cancer that increasingly can be identified by their genetic makeup, it stands to reason that different treatments would work better for those different cancers. And we're only at the beginning stages of developing these more focused and specific treatments. But the idea is to try to replicate that system of finding a specific breast cancer and finding a specific treatment for all breast cancers.

KELLY: I wonder, to what extent does funding drive the research? Is one challenge getting pharmaceutical companies and securing federal funding to focus on the goal of eradication of the disease versus better drugs to treat it once it's diagnosed?

LERNER: This is a real important issue, and a lot of groups have been pushing in this direction and really trying to change the paradigm, trying to get the rate of breast cancer to go down by itself so we don't have to do all this aggressive treatment. Getting research funding into those areas is much more of a challenge.

KELLY: And why is that?

LERNER: Many reasons. One is they're much harder studies to do. It's easy to put two drugs against each other and follow a group of women out. It's much harder to do studies, for example, of what sort of toxins in the environment might be causing breast cancers in a group of women.

In studies like that, you've got to interview people, try to figure out what they've been exposed to, for how long a period. And then you have to follow them for years and years. They're very, very difficult studies to do, and they're not very sexy from the perspective of a pharmaceutical company. Why would a pharmaceutical company want to fund that? And there's limited federal dollars for this sort of research. But that's absolutely a productive way that we should be pushing.

KELLY: Dr. Lerner, the advice that a lot of women get tends to focus heavily on prevention, on early detection, as we've been talking about. You know, we're all told to eat well, don't smoke, get screened, get your recommended mammograms. It does seem that in the race for the cure, the cure doesn't really get discussed that much.

LERNER: That's true. I think the challenge is to try, again, to look at the bigger picture. What's clear is even though the mortality has gone down and is under 40,000 deaths a year, there's still, we could say, hundreds of thousands of new cases of breast cancer a year regardless of the screening technique that you're talking about. And the incidence of breast cancer, the number of cases, has stayed roughly the same in that range for many, many decades, really.

KELLY: Despite all of these decades of research and funding and trying to turn that - those numbers around.

LERNER: That's exactly what you'd expect because we've been focusing not on eradicating breast cancer. We've been focusing on finding it and curing it. So that's why the rates of the disease haven't changed, but the death rate has gone down. So we've done a good job of finding cancers once they're there and treating them. We haven't done as good a job of saying how do we prevent these cancers from occurring in the first place.

KELLY: Dr. Barron Lerner of Columbia University. That focus he mentioned on finding and treating breast cancer has benefited women like Tracy Grant. Her cancer was caught early, and she never had to endure some of the most painful treatments that older generations of her family did.

GRANT: I feel tremendously blessed because I had these matriarchs before me. You know, I watched them go through such a difficult time in the chemotherapy. And I was prepared, and I had a double mastectomy, which is nothing to sneeze at, but I did not have to go through chemo or any medication. I was very, very lucky.

KELLY: Tracy's mom, Catherine, puts it a different way. The two-time cancer survivor looks healthy, beautiful today at age 74. And she says that while the disease is part of her family's history, it does not define them.

GRANT: Believe it or not, and this might sound a little strange, but when we have family gatherings, the breast cancer never comes up.

KELLY: Really?

GRANT: No.

KELLY: That surprises me.

GRANT: No.

KELLY: It's something you all have in common, or so many of you.

GRANT: Yeah. We, you know, we know we have it. As long as everyone is healthy, and there's no problems, you know, somebody might say, well, so and so has a cold. Well, yeah, we might talk about that. But breast cancer, no. We don't. We never just sit down and have conversations about breast cancer because we've all just adjusted to living with it, and we've moved on.

KELLY: Catherine Grant, talking about three generations in her family who have fought breast cancer. And by the way, they all beat it.

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