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October is National Breast Cancer Awareness Month, a time to raise awareness of breast cancer and highlight the research advancing prevention, early detection and treatment. At the University of Cincinnati Cancer Center, researchers are working to improve treatment strategies, better understand how individual cancers respond to therapy and help patients achieve the best possible outcomes while minimizing long-term side effects.
Breast cancer is the most commonly diagnosed non-skin cancer among women in the United States. About one in eight women will be diagnosed with breast cancer during their lifetime. Although less common, breast cancer can also occur in men. Screening and advances in treatment have significantly improved survival, but breast cancer remains a complex disease with different subtypes that can behave and respond to treatment differently.
“Breast cancer is not just one disease,” said Teresa Meier, MD, a member of the Experimental Diagnostics & Therapeutics Research Program at the Cancer Center. “Cancers that are hormone receptor-positive, HER2-positive and triple-negative all behave differently.”
Teresa Meier, MDMember, Experimental Diagnostics & Therapeutics Research ProgramUniversity of Cincinnati Cancer Center
These biological differences influence treatment decisions and underscore the importance of tailoring care to each patient. For researchers and clinicians, the goal is not simply to treat cancer, but to determine which treatments are most likely to benefit each individual while avoiding unnecessary interventions and their potential long-term effects.
One of the central challenges in breast cancer care is finding the right balance between effective treatment and quality of life.
“Survival has improved drastically through screening and better systemic therapy,” Meier said. “The goal is to treat smartly and avoid both undertreatment and overtreatment. We aim to provide personalized care for each individual patient — who needs more treatment and who can undergo omission of some therapies.”
An increasingly important area of breast cancer research is treatment de-escalation, i.e. identifying circumstances in which patients may safely receive less treatment without compromising outcomes. Although surgery, radiation and systemic therapies have helped improve breast cancer survival, treatment can also cause short- and long-term side effects. Researchers are investigating whether some patients can avoid specific treatments or undergo less extensive procedures based on their disease characteristics and response to therapy.
In radiation oncology, for example, researchers are studying whether radiation can be safely omitted for selected patients with favorable early-stage breast cancer or for patients who have no residual cancer identified at surgery after receiving treatment before a mastectomy. Other studies are evaluating ways to minimize axillary surgery, which involves removing and examining lymph nodes under the arm. Depending on the patient's circumstances, approaches under investigation include omitting sentinel lymph node biopsy or using targeted axillary dissection instead of a more extensive axillary lymph node dissection.
At the same time, advances in targeted therapies are helping clinicians tailor treatment to individual tumor characteristics and treatment response. HER2-directed therapies have expanded treatment options for HER2-positive breast cancer, while immunotherapy combined with chemotherapy has become a standard treatment approach for certain patients with triple-negative breast cancer. CDK4/6 inhibitors, a class of oral targeted therapies, are also used for some patients with hormone receptor-positive breast cancer.
These advances have been guided by large randomized clinical trials that evaluate treatment effectiveness and safety. Continued research is essential to determine which patients benefit most from specific therapies, when treatment can be reduced and how care can be adapted as new evidence emerges.
The University of Cincinnati Cancer Center participates in national cooperative research efforts while also supporting investigator-initiated studies designed to address clinical questions and improve care locally. Several clinical trials available at the Cancer Center are examining ways to personalize treatment, reduce unnecessary therapy and improve the patient experience.
“The OptimICE-pCR trial is studying patients with triple-negative breast cancer who achieve a complete pathologic response after receiving chemotherapy and immunotherapy before surgery,” shared Meier. “A complete pathologic response means no residual cancer is found in the tissue examined at surgery. The trial compares observation, with no additional immunotherapy after surgery, versus continued immunotherapy which is the current standard of care, to determine whether further treatment is necessary for these patients.”
Similarly, the ShortStop-Her2 trial is evaluating whether patients with HER2-positive breast cancer who achieve a complete pathologic response after preoperative treatment can receive six months of HER2-directed therapy rather than the standard 12 months. Both studies address a central question in personalized care: when a patient responds exceptionally well to initial treatment, can additional therapy be reduced without compromising outcomes?
“Other clinical trials are exploring ways to improve care beyond cancer control alone,” said Meier. “An investigator-initiated trial led by Alicia Heelan, MD, is comparing preoperative and intraoperative pectoral nerve blocks to evaluate approaches to reducing pain after mastectomy.”
Meier and her colleagues have also participated in the RADCOMP trial, a national, multi-institutional phase III randomized study comparing proton and photon radiation therapy for patients with nonmetastatic breast cancer who require radiation to the breast or chest wall and regional lymph nodes. The trial completed enrollment in 2024 and is designed to determine whether proton therapy may help further decrease cardiac events over time. Although the full results will take longer to emerge, investigators have examined patient quality of life following proton and photon therapy.
Meier emphasized that clinical trials are essential to continuing progress in breast cancer treatment.
“Almost all our treatment recommendations are evidence-based,” she said. “We have results from large, randomized trials that guide our current treatment recommendations, but that is the importance of research. Nothing is ever perfect. We are continuing to ask what can be done to improve a patient's outcome — whether that is decreasing a chance of recurrence or minimizing a side effect related to treatment.”
By participating in national trials and developing studies right here, the Cancer Center helps connect patients in the Cincinnati region with research that may shape future standards of care.
“Having these clinical trials open in Cincinnati allows patients access to potential cutting-edge technology or treatment,” Meier said.
Across breast cancer research at the University of Cincinnati Cancer Center, treatment personalization and survivorship remain closely connected priorities. Improving outcomes means more than eliminating cancer; it also means helping patients maintain their health and quality of life after treatment.
“As a whole, the focus has been on de-escalation and personalized medicine for breast cancer,” Meier said. “The focus is not just on killing the cancer and curing patients, but also on survivorship and life after breast cancer treatment. We want to minimize the long-term side effects related to our treatment.”
This approach involves collaboration across the breast cancer team, survivorship services, integrative medicine and oncology primary care. By working across these areas, clinicians and researchers can address patients' immediate treatment needs while also considering the longer-term effects of care.
The RADCOMP trial illustrates this broader approach by examining whether the type of radiation therapy used can influence future cardiac health. Other studies focused on reducing treatment intensity or limiting the extent of surgery similarly seek to preserve the benefits of cancer treatment while reducing its potential burden.
Research is also needed to understand why some breast cancers recur or spread despite treatment. Although current therapies are guided by evidence from large clinical trials, not every patient responds in the same way. Investigating the biological factors that contribute to treatment resistance and recurrence could help researchers identify new therapeutic strategies and determine which patients may benefit from different approaches.
Meier also pointed to the increasing number of breast cancer diagnoses among younger patients as an important area for future investigation.
“We have started to see a rise in breast cancer in younger patients and some with no family history,” she said. “The biggest question is why?”
Understanding the factors contributing to these diagnoses may help researchers improve risk assessment, prevention and early detection strategies. Researchers must also continue investigating why some cancers become resistant to treatment and how those resistance mechanisms can be overcome.
The Cancer Center's participation in national cooperative trials and its support for studies developed here allow researchers to contribute to broader advances in breast cancer care while addressing questions relevant to patients in the Cincinnati region.
During National Breast Cancer Awareness Month, these efforts highlight how continued research can improve care at every stage — from identifying effective treatments to determining when therapy can be safely reduced, preventing recurrence and supporting life beyond cancer treatment. As Meier and her colleagues continue to investigate these questions, their work reflects a central goal of modern breast cancer care: delivering the treatment each patient needs while minimizing the lasting effects of the disease and its treatment.