Duke Cancer Institute’s breast oncology program offers advanced diagnostics, genetic and prevention counseling, as well as the full scope of treatments for early, advanced-stage, metastatic, and rare forms of breast cancer.
Visit DukeHealth.org for more information about breast cancer treatment.
The Duke breast oncology program provides highly specialized care for all types of breast cancer, from the most common type, ductal carcinoma, to more aggressive and rare types of breast cancer such as inflammatory breast cancer, and phyllodes tumors.
Many of our specialists are nationally recognized for their breast cancer expertise. The team’s groundbreaking research has resulted in the FDA approval of breast cancer treatments. Most recently, research that originated in a Duke Cancer Institute laboratory contributed to the FDA approval of elacestrant, the first new endocrine therapy for breast cancer in more than 20 years. It is the only drug designed to target mutations in estrogen receptor 1 (ESR1).
The new therapy, a selective estrogen receptor down regulator (SERD), was approved by the FDA in January 2023 for the treatment of estrogen receptor-positive/HER2-negative ESR1-mutated advanced or metastatic breast cancer in patients who were not treated successfully with at least one previous endocrine therapy.
Areas of Expertise
Duke breast medical, surgical, and radiation oncologists specialize in treating benign and malignant breast disease as well as high-risk conditions. Specifically, our areas of expertise include:
Advanced Screening, Prevention, and Treatment
As a team, we are experts in assessing breast cancer risk, hereditary breast cancer, and the use of high-risk screening. Our board-certified breast imaging specialists are trained in the early detection of breast cancer and the identification of abnormal breast imaging.
Screening starts with mammography, followed by breast ultrasounds and breast MRIs. We use fast breast MRI and contrast-enhanced breast MRI to capture clearer images and locate small lesions that can be missed on mammography. This is especially important in younger women with dense breast tissue and in women with breast implants.
Our breast cancer team partners with Duke researchers who have basic, translational, and clinical research interests in breast cancer. Our clinical trials study new ways to diagnose, prevent and treat breast cancer, and improve survivors’ quality of life. The trials give eligible breast cancer patients access to new therapies before they are approved.
Areas of Focus
Our physicians are investigating new ways to approach breast tumors, how exercise impacts treatment and survival, and how to improve the quality of our patients’ lives. Our trials test new vaccines to treat different types of breast cancer, including early-stage breast cancer and HER2-positive breast cancer.
These subprograms focus on translating basic science discoveries to impact the early detection and treatment of breast cancer:
Early detection strategies for breast cancer
Epigenetic therapy in breast cancer treatment
Basic breast cancer biology and novel therapeutic targeting
Disparities in breast cancer care
Duke Consortium for Inflammatory Breast Cancer
The Duke Consortium for Inflammatory Breast Cancer brings together investigators and clinicians to better understand, prevent, and treat inflammatory breast cancer. The Consortium works with advocates and community health providers as well as the World IBC Consortium investigators across many institutions.
Recent discoveries in genetics and genomics hold great promise. Our multi-disciplinary research team hopes to translate these discoveries into the next generation of targeted therapeutic approaches for the prevention and treatment of breast cancer.
Gayathri Devi, PhD, professor of Surgery and of Pathology, Duke University School of Medicine, and Duke PhD student Larisa Gearhart-Serna are senior and lead authors of a paper that found that urban environmental exposures drive increased breast cancer incidence. (The poster behind them is unrelated to this specific study.)
A Duke Health analysis of breast cancer in North Carolina showed that the state’s urban counties had higher overall incidences of disease than rural counties, especially at early stages upon diagnosis.
The findings, appearing in the journal Scientific Reports, serve as a national template for assessing the impact of poor environmental quality across different stages of breast cancer, which is marked by highly diverse origins and mechanisms for spreading.
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According to the National Institutes of Health (NIH), an estimated 623,405 people in the U.S. were living with metastatic melanoma, breast, lung, prostate, bladder, or colorectal cancer in 2018. By 2025, the prevalence will increase by an estimated 11%.
While melanoma and colon cancer commonly metastasize to the brain, and prostate cancer often advances to the spine, lung and breast cancer tend to metastasize to both the brain and spine.
"An increasing number of patients need treatment for cancer-related brain or spine metastasis, and for a potentially longer continuum of care," says breast medical oncologist Rani Bansal, MD, of the Duke Cancer Institute (DCI).
The Duke Center for Brain and Spine Metastasis (DCBSM) recently expanded its services to Duke Cancer Center Raleigh, now offering a specialized multidisciplinary approach to care for patients throughout the Triangle affected by any cancer that metastasizes to the brain or spine.
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Karen Kump of Elko, Nevada, knew the lump on her right breast should be checked by a doctor when she first noticed it in July 2022. “But my granddaughter was getting married, and I wanted the attention to be on her,” she said. Kump, 78, didn’t know the mass was a rare type of breast cancer called a phyllodes tumor. Within two months, Kump needed a mastectomy because it had grown so big, so fast. Now, the retired schoolteacher is participating in phyllodes tumor research at Duke Health. “I’m hoping others might benefit from what I went through,” she said.
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Breast surgical oncologist and Mary and Deryl Hart Distinguished Professor of Surgery Eun-Sil Shelley Hwang, MD, MHS, with Oluwadamilola "Lola" Fayanju, MD, MA, MPHS, FACS, in early 2020.
Dr. Hwang was Chief of Breast Surgery at Duke at that time and Dr. Fayanju was an assistant professor of Surgery, Division of Surgical Oncology. Dr. Fayanju is currently Chief of the Breast Surgery Division at Penn Medicine.
A study initiated at Duke University School of Medicine lays bare significant racial and gender disparities in America’s surgical leadership.
Of the 2,165 faculty members included across 154 departments, men overwhelmingly claimed the top spots in surgical leadership, making up 85.9% of department chairs, 68.4% of vice chairs, and a staggering 87% of division chiefs.
What’s more a mere 8.9% of these leadership roles were filled by those from underrepresented racial or ethnic groups.
While women made a modest showing as vice chairs at 31.6%, they remained underrepresented elsewhere. Many of these women and those from underrepresented racial or ethnic groups were clustered in roles linked to diversity and faculty development, which might not pave the way to top department positions.
The study in JAMA Surgery — led by Oluwadamilola “Lola” M. Fayanju, MD — stands out because the research team of surgeons, trainees, and biostatisticians looked in detail at different leadership roles and the implications these disparities have for the pipeline to department chair.
CONTINUE READING at the Duke University School of Medicine Newsroom
Hannah Woriax, MD, cares for patients in Lumberton and Laurinburg through the Duke Cancer Network.
Hannah Woriax, MD, assistant professor of Surgery, joined Duke in 2021, settling in her hometown of Pembroke, North Carolina, after completing residency at Virginia Tech’s Carilion School of Medicine and fellowship at the University of Alabama Birmingham. She returned to North Carolina with the goal of establishing a means of care and research for breast cancer patients in rural North Carolina communities.
She practices at both the Gibson Cancer Center in Lumberton and the Scotland Cancer Treatment Center in Laurinburg, both part of the Duke Cancer Network.
“The median income in this area is about $35,000, so quite a few patients do not have access to a full-time vehicle, and most people live at least 15-20 minutes away from wherever they’re being seen,” Woriax said. She works to establish a rapport with both her patients and her staff, communicating the importance of working with and around the patient’s means and abilities.
Woriax’s journey into medicine was kick-started by watching her grandfather, former Navy corpsman and family medicine physician Frank Woriax, MD, who was the first Native American to graduate from the Duke University School of Medicine.
The junior Dr. Woriax learned from her grandfather, whom she affectionately refers to as “papa,” the importance of giving back to their home community of rural and native North Carolinians.
“I came home to practice here because I knew that our patients deserve just as much access to care as the patients that live in more urban areas. And I can be a voice for our patients in a different space,” Woriax said, emphasizing her own credibility to both her patients and the support of the Duke Health system. “I work here, I grew up here, and I live here now. I understand the way of life and challenges on a different level.”
For Woriax, it is also important that care providers understand the historical nature of patient education in rural areas, particularly the lasting distrust for the medical community among the Native American and Black populations. “A lot of people here still see no difference in how we currently practice medicine and how experiments were conducted only decades ago,” she said. “So for me, for breast cancer patients specifically, I need to educate my patients on what their options are and why they would benefit from things like genetic testing, without any negative or malicious intent.”
Being Lumbee herself helps Woriax further establish credibility and trust with her patients, several of whom have known her since she was a child. “I long for those meaningful and long-term relationships with my patients and their loved ones,” Woriax said. “I tell my patients every time I meet them, ‘Don’t worry, you won’t lose me. We’re in each other’s lives now.’”
Woriax said that she hopes the Lumberton and Scotland locations will serve as prototypes for additional programs in the future. “Our goal is to identify where these gaps are and try to build a bridge for patients in a way that’s meaningful for them and long lasting and sustainable for the community.”
Research that originated in a Duke Cancer Institute (DCI) laboratory contributed to Food and Drug Administration (FDA) approval of the first new endocrine therapy for breast cancer since 2002, and the only drug designed to target mutations in estrogen receptor 1 (ESR1).
Donald McDonnell, PhD, associate director For translational research at DCI and the Glaxo-Wellcome Distinguished Professor of Molecular Cancer Biology, directed the research team that led to the development of elacestrant (Orserdu, StemlineTherapeutics, Inc).
The new therapy, a selective estrogen receptor down-regulator (SERD), is indicated for the treatment of postmenopausal women or adult men with estrogen-receptor-positive/HER2-negative ESR1-mutated advanced or metastatic breast cancer who have been treated unsuccessfully with at least one previous endocrine therapy.
The FDA approved the therapy in January 2023.
Mounting data supports the growing specialty of cardio-oncology, which aims to monitor and protect patients’ cardiac health throughout and after the completion of cancer therapy. It is particularly relevant for women with breast cancer, the most common malignancy among women worldwide and a leading cause of cancer-related deaths. Post-menopausal women who have survived breast cancer are at greater risk of dying of cardiovascular disease than recurrence of their breast cancer.
Breast oncologist and associate director of breast cancer clinical research at Duke Cancer Institute Susan Dent, MD, and cardiologist Michel Khouri, MD — both of whom are cardio-oncology experts — lead the Duke Cardio-Oncology program, which focuses on reducing the burden of cancer and cardiovascular disease.
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Research from a team led by DCI breast surgical oncologist and Chief of Breast Surgery Maggie DiNome, MD, reveals that younger African American women may face a molecularly unique form of triple-negative breast cancer. The discovery,published in JAMA Network Open, could lead to more effective treatments.
READ the story in the School of Medicine newsroom
Through a multidisciplinary workflow, the Duke Breast Oncology Program tripled point of care (POC) genetic testing rates among patients with an active breast cancer diagnosis, powering the team to reach more patients faster.
Jennifer K. Plichta, MD, surgical oncologist and co-director of cancer genetics at Duke Cancer Institute (DCI) explains, “POC genetic testing is a standard part of each qualifying patient’s first appointment. A test is initiated, the genetics team is engaged, and we move forward together.”
For patients, this model eliminates additional referrals and appointments for genetic testing.
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Duke Cancer Institute psychologist Rebeca Shelby, PhD, is featured in a new Medscape video series "Better with Age: Improving Breast Cancer Care in Older Adults."
Nearly 20% of women diagnosed with breast cancer are over 75. With an increasing older population, comes a growing number of breast cancer patients. Older breast cancer patients commonly pose "distinct clinical challenges, such as frailty, co-morbidities, and limited functional independence" and "age bias may even limit patient access to approved therapies." This ageism, coupled with an underrepresentation of older adults in clinical trials, can affect breast cancer treatment outcomes.
In a new six-part MedscapeTV series — "Better with Age: Improving Breast Cancer Care in Older Adults" — a multidisciplinary DCI team and a UNC Lineberger Comprehensive Cancer Center team "share insights on current standards of care for older breast cancer patients and emphasize the importance of shared decision-making. They discuss comprehensive geriatric assessment as a critical yet underutilized tool, and discuss factors that affect the quality of life of older breast cancer patients."
DCI breast oncologist Gretchen Kimmick, MD, DCI psychologist Rebecca Shelby, PhD, and Duke Health physical therapist Lisa Massa, CLT, PT, WCS, offer some strategies for optimal treatment of these cancer patients.
The series was launched in March and continues through this fall.
WATCH the Series
On September 13, the White House Cancer Moonshot program announced its support for and commitment to several new projects to "end cancer as we know it," including a new initiative led by TOUCH, the Black Breast Cancer Alliance, to bolster Black women’s breast cancer clinical trial participation by 2025 — with the goal of reaching 350,000 Black women and motivating 25,000 into trial portals.
The White House also announced a connected program, TOUCH Care, the first program to provide a nurse navigator service to assist Black breast cancer patients in clinical trials. This will include developing culturally-agile recruiting materials, training trial staff, and coaching patients. TOUCH Care is being led by TOUCH co-founder and Duke Cancer Institute patient navigator and patient navigation manager Valarie Worthy, MSN, RN, and piloted with Genentech, which will add five breast cancer clinical trials annually.
Worthy, a two-decade-plus breast cancer survivor, has been a nurse for more than 38 years and worked at Duke for the past 19 years. Her hometown is Ahoskie, in northeastern North Carolina.
VIEW White House Fact Sheet
VIEW Genentech Press Release
UPDATE JAN. 27, 2023:Today the FDA approved the targeted therapeutic Elacestrant to treat certain postmenopausal women or adult men with advanced or metastatic ER-positive, HER2-negative, ESR1-mutated breast cancer after one or more lines of endocrine therapy.LEARN MORE
More than 1.5 million women in theU.S. are currently on endocrine therapies (hormone therapies) for breast cancer — either as monotherapiesor in combination with other drugs.
These drugs and drug combinationshave been found to work well, in somecases for many years until they don’t. Recently it has been demonstrated that mutations can develop in genes within breast cancer cellsthat render even the best endocrine therapies ineffective. While moreand more women are living with stage 4 breast cancer (upwardof 150,000), 42,000 die of metastatic breast cancer each year.Metastasis, cancer that has spread to distant organs, is the majorcause of breast cancer death.
The majority of breast tumors (~75%) have receptors for estrogens within cancer cells and such cancers are classified as ER+. When estrogens bind to these receptors, they can drive processes responsible for tumor growth and metastasis.
One type of anti-estrogen hormone therapy (endocrine therapy) — aselectiveestrogenreceptormodulator (SERM) — works by binding to the estrogen receptors present in cancer cells and in the body’s immune cells. This stops the estrogens from binding and driving cancer cell growth. Another type of endocrine therapy, aromatase inhibitors, suppresses estrogen synthesis.
SERMs (such as tamoxifen), aromatase inhibitors (such as anastrozole, letrozole, or exemestane), andcyclin-dependentkinase 4/6 inhibitors (therapies that target the CDK4 and CDK6 enzymes important to cell division, such as abemaciclib, ribociclib, and palbociclib) — taken alone or in combinations thereof — are currently used as first- and second-line treatments for ER+ breast cancer. (CDK 4/6 inhibitors are targeted therapies, not endocrine therapies)
Unfortunately, the majority of patients with metastaticER+breast cancer will eventually develop resistance to these drugs.
When this happens, oncologists may try a different type of endocrine therapy, aselectiveestrogenreceptordownregulator (SERD),which, like a SERM works bytargeting the estrogen receptor in cancer cells and the body’s immune cells, but instead ofblocking estrogen bybindingto theestrogen receptor like a SERM, itblocks estrogen bydegradingthe estrogen receptor.
The only drug of this class (SERD) approved for clinical use in ER+ breast cancer is fulvestrant (first FDA-approved in 2002), which has been shown to have only modest efficacy.Additionally,as an injectable drug, the administration of fulvestrant can be very uncomfortable for patients.
