The episode begins with Dr. Beitsch discussing his training and how he became interested in studying the appropriateness of certain cancer treatments. As a member of the American Society of Breast Surgeons, Beitsch helped begin a registry with Agendia, where he learned the importance of sub-typing through BluePrint. He says, “It turns out the subtyping is important for breast cancer, because there are many kinds of cancers. Hundreds.” During a related study, he and his team discovered that in 20% of ER-positive patients, which are classically luminal patients, patient tumors were not turned on by estrogen receptors and were actually a basal type. Immunostaining alone would have suggested that those patients were luminal type and would respond to anti-estrogen therapy, but deeper investigation revealed that, in fact, they needed to be treated for basal cancer.

 

Breakthroughs like these are what inspired Dr. Beitsch to look more closely at how population-based treatments have been applied in the past, and why they were not working for every patient. He notes that his interest in precision medicine is not uncommon for a surgeon. In fact, the process of tumor profiling in precision medicine was started with surgeons, because the tissue was required to be fresh or flash-frozen and needed to be harvested in surgery for gene sequencing. Therefore, surgeons tended to be the early voices advocating for precision medicine—often clashing with medical oncologists as a result.

 

The problem with implementing precision medicine in the beginning, he says, is that many oncologists were slow to change their views on genomic testing. However, once they realized that deeper testing could help prevent patients from getting treatments that were not going to work for them—and might actually harm them—they were more receptive. Today, Beitsch believes surgeons and oncologists are on the same page and that the emphasis on precision medicine will continue to grow.

 

He says, “The more we look at things precisely, the more we find out and the better we get. Just in my 25-year career, survivals in breast cancer have gone up by 50% or maybe more.” He credits these advancements to the move away from population-based treatments and towards genomic testing.

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Listen to the full episode of Part Two above.
 

Be sure to listen to Part 1, where Dr. Beitsch, discusses his study published by the Journal of Clinical Oncology titled, Underdiagnosis of Hereditary Breast Cancer: Are Genetic Testing Guidelines a Tool or an Obstacle? During the episode, he spoke in-depth about the results of that study and the implications for the future of precision medicine in cancer care.

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Download the full transcript of either episode here (pdf).

 

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