Imagine a world where breast cancer treatment is tailored so precisely that no patient endures unnecessary pain or side effects. This isn’t just a dream—it’s a possibility on the horizon. Researchers from the University of Kansas Medical Center and the University of Michigan have uncovered a groundbreaking approach: capturing cancer cells directly from a patient’s blood to guide treatment decisions. But here’s where it gets controversial—could this method render some aggressive treatments obsolete for certain patients? Let’s dive in.
In a study published in Science Advances (https://www.science.org/doi/10.1126/sciadv.adz0187), scientists propose that analyzing cancer cells in the blood could help doctors distinguish between patients who truly need aggressive interventions—like surgery, radiation, or anti-hormonal therapy—and those who might safely opt for less invasive options. “Our goal is to identify biomarkers that act as a roadmap, guiding us to the most effective treatment for each individual,” explains Fariba Behbod, Pharm.D., Ph.D., a professor of pathology and laboratory medicine at KU Medical Center and a study author. “This could spare patients from unnecessary procedures while ensuring those who need aggressive care receive it.”
Consider this: of the 2.3 million women currently battling breast cancer, about a quarter are diagnosed with ductal carcinoma in situ (DCIS), an early-stage cancer that hasn’t spread. While these patients often have a favorable prognosis, the cancer can turn invasive in 10% to 53% of untreated cases. With no reliable way to predict which patients are at risk, doctors typically recommend aggressive treatments like lumpectomies, mastectomies, or radiation therapy. But what if we could pinpoint who truly needs these interventions?
“Early detection has led to more young women facing life-altering decisions,” says Sunitha Nagrath, Ph.D., a professor of chemical engineering at the University of Michigan and study author. “Right now, patients are often presented with treatment options without clear data on which one aligns best with their individual risk. This research could change that.”
Here’s the part most people miss: some patients undergo aggressive treatments despite their cancer being unlikely to spread, while others may receive insufficient care. Research shows that cancer recurs within 10 years for about 10% of patients treated with surgery alone. The key lies in detecting circulating cancer cells in the blood—cells that shed from tumors and evade traditional lab techniques. These cells can potentially seed new tumors, making their detection critical.
Enter the labyrinth chip, a revolutionary device developed by Nagrath and Max Wicha in 2017 (https://news.umich.edu/labyrinth-chip-could-help-monitor-aggressive-cancer-stem-cells/). This chip’s maze-like channels separate larger cancer and white blood cells from smaller blood cells, allowing researchers to isolate and analyze cancer cells from just a few milliliters of blood. In the study, the team used this chip to collect cancer cells from 34 DCIS patients at KU Medical Center, comparing them to cells from breast tissue biopsies.
The findings were eye-opening. Cancer cells from tissue biopsies fell into four subtypes based on active genes, two of which were found in significant levels in the blood. These subtypes were linked to disease progression, chemotherapy resistance, and platelet binding—a mechanism some researchers believe helps cancer cells evade the immune system. “This narrows down the factors that indicate why these cells circulate in the blood,” says Neha Nagpal, a University of Michigan doctoral student and the study’s first author.
A controversial yet crucial finding emerged: Black patients in the study tended to have more cancer cells in their blood and higher immune suppression compared to white patients. This aligns with higher breast cancer mortality rates in Black patients (https://jamanetwork.com/journals/jamaoncology/fullarticle/2427491). While race itself isn’t a biological factor, these disparities likely stem from environmental and systemic issues. Is this a call to address deeper inequalities in healthcare?
Looking ahead, the team plans to track which cancer cell types and biomarkers lead to metastasis by transplanting patient cells into mice. After four months, the mice showed elevated cancer cells in their blood, which were collected for gene sequencing. The researchers will also monitor disease progression in both mice and human patients.
Funded by institutions like the University of Michigan Forbes Institute for Cancer Discovery and the National Center for Advancing Translational Sciences, this research is a beacon of hope. But it also raises questions: Could this method revolutionize breast cancer treatment, or will it face hurdles in clinical adoption? What does this mean for healthcare disparities? We’d love to hear your thoughts—share your opinions in the comments below!
