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Breast cancer is the second most common cancer among women and the second leading cause of cancer-related deaths among women in the US. In light of Breast Cancer Research Awareness Day, The American Journal of Managed Care® breaks down the most recent advancements in breast cancer prevention, screening, and therapies.
Breast cancer is the second most common cancer among women and the second leading cause of cancer-related deaths among women in the US.1
Nevertheless, the National Institute of Cancer (NCI) is committed to advancing breast cancer research to improve prevention, detection, and treatment as The American Journal of Managed Care® (AJMC®) highlights these efforts in recognition of Breast Cancer Research Awareness Day on August 18.2 Now, while there is a plethora of research dating back decades, more recently, there are a couple of significant advancements related to breast cancer screenings, therapies and treatment, NCI-supported research programs and clinical trials, and discoveries about breast cancer itself, many of which have potential for major impacts in breast cancer treatment and positive patient outcomes.
First, let’s dive into breast cancer screenings and prevention. Mammography is the primary screening tool for effective breast cancer screening for individuals with average risk. Magnetic resonance imaging, or MRIs, and ultrasound can also be used but are less frequently used for women with above-average risk.2
Mammograms are an X-ray tool that can detect lesions, calcifications, and other abnormal masses or changes in breast tissue. Over the last 50 years, there have been significant innovations to mammographs, but the most recent innovation is the implementation of artificial intelligence, or AI, which can be associated with improved early detection.² With over 2 million new cases reported in 2020, the need for more effective early diagnosis advancements is crucial for reducing the mortality rate, enhancing treatment effectiveness, and improving patient outcomes.
SimonMed, one of the largest outpatient medical imaging providers in the US, introduced its new AI-enhanced mammogram service, Mammogram+. SimonMed partnered with iCAD, a company responsible for Profound AI, which is an AI-powered mammography detection software. iCAD reported that with their software’s overall diagnostic accuracy in hard-to-find cancers improved by 22% and showed an 18% improvement in reducing false positives when reading 2D and 3D mammographs and digital breast tomosynthesis screenings.
And this is not the only instance in which AI has been used to enhance mammographs. Digital breast tomosynthesis, or DBT—which is used to obtain multiple projections to produce a 3-dimensional and sectional image of the breast—helps overcome obstructions like tissue overlap, or, more specifically, dense breast tissue that can make detecting some breast lesions more difficult. 3 DBT utilizes full-field digital mammography, which is common amongst most practices. However, DBT, unlike full-field digital mammographs, or FFDs, uses a series of low-dose 2D x-ray images from multiple different angles around the breast, which are then computed to produce a 3D volumetric image of the breast.4
The digital reconstruction significantly improves visualization of lesion edges and reduces diagnostic errors, thus lowering the occurrence of false negatives. A recent study published in the National Library of Medicine has introduced AI deep learning technology with DBT to help improve digital reconstruction and analysis. AI deep learning, when used with DBT and radiologists, has led to substantial increases in patient survival due to improved speed and accuracy in detecting and diagnosing lesions.4
On the other hand, while researchers have seen success using deep learning with DBT, there are still a few hurdles to overcome. One of the main challenges of applying deep learning and other AI models to DBT is the interpretability and lack of transparency in decision-making, which in turn makes it harder for doctors to detect and correct interpretive errors, resulting in misdiagnoses like false negatives.However, that’s not the end-all be-all. Currently, strategies to improve the interpretability of deep learning models by introducing things like innovative neural network architectures and visualization techniques that can help doctors to better understand the decision-making process of the AI model, in addition to a multiview feature fusion, which combines information from multiple angles and image types, help create a complete and more reliable image to further help doctors come to a concrete conclusion.4
Nevertheless, enhanced mammograms have the potential to advance early detection. The 5-year survival rate of patients with stage I breast cancer is 100% when compared with patients with stage IV disease, whose survival rate then drops to 25%.4 These data just go to show how crucial early detection and diagnosis are in improving outcomes and overall survival.
Although breast cancer is the second leading cause of cancer-related deaths among women in the US, Black women have a 40% higher mortality rate from breast cancer than White women as of 2024, according to the HHS Office of Minority Health. 5 Recent studies attribute high misdiagnosis rates and even higher prevalence of aggressive cancers to disproportionate access to screenings—which in turn delays diagnosis—and genetic differences that predispose Black and African American women to more aggressive cancers like triple-negative breast cancer.6-8
While we’re still relatively fresh off the topic of breast cancer screenings, in recent news, Pennsylvania passed a law eliminating costs for supplemental screenings for women with an established risk of breast cancer, genetic predispositions, or heterogeneously dense breast tissue, among other criteria. However, if we narrow in on women with dense breast tissue—which Black women are more likely to have—they still were ineligible to receive supplemental screenings under this law based on the breast density and breast cancer risk standardized guidelines.7 Women with dense breast tissue have a risk of breast cancer 5 times that of women with non-dense breast tissue, and they also have higher rates of false-negative mammograms.
Now, under this law, the measurement tools used were the Breast Imaging and Reporting Data System, or BI-RADS, which set the parameters for breast tissue density, and the Breast Cancer Risk Assessment, or BCRAT, which calculates lifetime risk of breast cancer. A recent clinical trial measuring outcomes for supplemental screenings by race, under this Pennsylvania law, reported fewer cases of extremely dense breast tissue in Black women when compared with White women and even fewer with a BCRAT greater than 20%. Now, under this state-level legislation, a woman must have either heterogeneously dense or extremely dense breast tissue and a BCRAT score greater than 20%. However, with these stipulations, Black women had a sensitivity of 0%, meaning there were 0 false-negative mammograms in Black women that were correctly identified as eligible for supplemental screenings out of the 39,397 Black women in this study. However, when researchers adjusted for women missing BCRAT scores, Black women’s sensitivity rose to 53%.7
Another stipulation of the law recognized genetic risk, and while it was not investigated in the clinical trial, there are other studies that have. I briefly mentioned before that Black women are prone to more aggressive breast cancers like triple-negative breast cancer or inflammatory breast cancer.6 A recent study in NPJ Breast Cancer observed improved survival outcomes in Black women with triple-negative breast cancer and increased levels of regulatory T cells and overall T cell populations. These findings encouraged researchers to suggest more specific studies as to why Black women have a higher abundance of certain immune cell populations and how this can be used to advance breast cancer therapies.
Now if we zoom in a little further beyond the cell and look at our DNA, another study published in Nature Genetics found genetic variants at 12 loci associated with breast cancer risk, and among the 18,034 cases evaluated in this genome-wide association study, researchers found that 15.4% of cases with triple-negative breast cancer carried 6 out of the 12 risk alleles.7
All in all, while there is ongoing research to identify differences in breast cancer in Black women compared with other races and ethnicities, there is still more to be learned about genetic differences impacting how breast cancer presents in women by race and ethnicity and adjusting policies to account for these differences.
There is a plethora of treatments for breast cancer, including surgery, radiation, hormone therapy, chemotherapy, targeted therapy, and immunotherapy. More recently, researchers from Hebrew University made an advance in targeted therapy for breast cancer and developed a new “drug-like” molecule with the ability to degrade the RNA-binding protein, Hu antigen R, or HuR, which plays a crucial role in preserving oncogene cell proliferation, survival, and metastasis, critical processes that all promote oncogenic mRNA stabilization. The molecule MG-HuR2 reduced HuR levels by up to 80%, disrupting expression of downstream oncogenes and significantly inhibiting cell proliferation, survival, and 3D tumor spheroid growth. The study authors believe this discovery will pave the way for future studies aimed at RNA-binding protein degradation in cancers.9
Now, while this degrader has not yet made it to clinical trials, as the study was just published in early July of 2025, in 2023, however, the FDA approved an oral hormonal therapy, a selective estrogen receptor degrader, or a SERD, which is more effective than other hormone therapies in postmenopausal women and men with various subtype of breast cancer. These include estrogen receptor positive, or ER+, human epithelial growth receptor 2 negative, or HER2-negative, estrogen receptor alpha-1, or ESR1, mutated advanced or metastatic breast cancer. The brand name of the drug is Orserdu, produced by Stemline Therapeutics, Inc., and in the clinical trials, participants with the ESR1 mutation saw zero progression of their cancer for a little less than 4 months while receiving treatment when compared with patients on another hormone therapy, fulvestrant, an injectable SERD, who only saw their cancer progression stall for 2 months while receiving treatment.10
Another oral SERD, imlunestrant, was also shown to be more effective than traditional hormone therapies at slowing the growth of ESR1-mutant tumors in women with advanced ER-positive, HER2-negative breast cancer. And when combined with the cell growth blocker abemaciclib, the SERD was better in treating those with mutated and unmutated ESR1 tumors.11
In regard to immunotherapy, which helps the body’s immune system fight the cancer more efficiently and effectively, there have also been recent advancements in immunotherapy drugs, or immune checkpoint inhibitors. Evidence has shown that these inhibitors may improve how long someone with advanced breast cancer can live. This type of treatment is more common for individuals with advanced or more aggressive subtypes of breast cancer.10
The reported findings of a clinical trial on the outcomes of the immunotherapy drug pembrolizumab, published earlier this year in the National Library of Medicine, showed improved outcomes in patients with early-stage triple-negative breast cancer who were treated before and after surgery, leading to FDA approval. 10, 12
The progressive nature of hormone, targeted, and immune therapies alludes to promising advancements in breast cancer treatments that have the potential to improve outcomes amongst patients with various subtypes of breast cancer.
The NCI is also conducting clinical trials that assess and evaluate breast cancer screening, treatment, and prevention from multiple angles, with the goal of advancing knowledge and improving patient outcomes.
References
1. Breast cancer statistics. Centers for Disease Control and Prevention. June 10, 2025. Accessed July 31, 2025. https://www.cdc.gov/breast-cancer/statistics/index.html
2. Advances in breast cancer research. NCI. April 8, 2025. Accessed July 31, 2025. https://www.cancer.gov/types/breast/research#research-in-breast-cancer-treatment
3. Nicosia L, Gnocchi G, Gorini I, Venturini M, Fontana F, Pesapane F, et al., History of mammography: analysis of breast imaging diagnostic achievements over the last century. Healthcare (Basel). 2023;11(11):1596. doi:10.3390/healthcare11111596
4. Wang R, Chen F, Chen H, Lin C, Shuai J, Wu Y, et.al., Deep learning in digital breast tomosynthesis: current status, challenges, and future trends. MedComm (2020). 2025;6(6):e70247. doi:10.1002/mco2.70247
5. Cancer and Black/African Americans. Office of Minority Health. February 13, 2025. Accessed August 6, 2025. https://minorityhealth.hhs.gov/cancer-and-blackafrican-americans#footnote1
6. Omilian AR, Mendicino L, George A, et al., Quantitative analysis of T cell subsets in a population of Black women with invasive breast cancer. NPJ Breast Cancer.2025;11(1):64.doi:10.1038/s41523-025-00780-5
7. Mahmoud MA, Ehsan S, Ginzberg SP, Domchek SM, Nathanson KL, Conant EF, et.al., Racial differences in screening eligibility by breast density after state-level insurance expansion. JAMA Netw. Open. 2025;8(8):e2525216. doi:10.1001/jamanetworkopen.2025.25216
8. Jia, G, Ping, J, Guo, X, et al., Genome-wide association analyses of breast cancer in women of African ancestry identify new susceptibility loci and improve risk prediction. Nat Genet. 2020;56:819-826. doi:10.1038/s41588-024-01736-4
9. Kassabri L, Benhamou RI. Druglike molecular degraders of the oncogenic RNA-binding protein HuR. JACS Au. Published online July 16, 2025. doi:10.1021/jacsau.5c00551
10. Center for Drug Evaluation and Research. FDA approves elacestrant for ER-positive. U.S. Food and Drug Administration. Accessed August 8, 2025. https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-elacestrant-er-positive-her2-negative-esr1-mutated-advanced-or-metastatic-breast-cancer
11. Jhaveri KL, Neven P, Casalnuovo ML, Kim SB, Tokunaga E, Aftimos P, EMBER-3 Study Group. Imlunestrant with or without Abemaciclib in advanced breast cancer. N Engl J Med. 2025;392(12):1189-1202. doi:10.1056/NEJMoa2410858
12. Cardoso F, O'Shaughnessy J, Liu Z, McArthur H, Schmid P, Cortes J, Pembrolizumab and chemotherapy in high-risk, early-stage, ER+/HER2- breast cancer: a randomized phase 3 trial. Nat Med. 2025;31(2):442-448. doi:10.1038/s41591-024-03415-7
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