Science Made Simple: Dr. Julie Lang on the Future of Breast Cancer Research and Care
Dr. Julie Lang is a recognized breast cancer surgeon and researcher, and a member of ICRF’s Scientific Review Panel. Her work spans liquid biopsies, inflammatory breast cancer, and tumor biology, with a focus on developing more precise approaches to treatment. We asked her some questions about breast cancer research and treatment, including what she predicts for the future.
What is one thing people often misunderstand about breast cancer?
Most breast cancers occur in women with little to no family history of breast cancer. The hereditary form of breast cancer is responsible for only about 5-10% of all breast cancers. This is why it is so important for all women over age 40 to get a mammogram. If a patient has a greater than 20% lifetime risk of breast cancer based on family history and other factors, they may be eligible for enhanced screening with both mammography and breast MRI. Breast cancers detected by screening have much better outcomes than breast cancers detected only after a lump is present in the breast.
How is research, including your work on liquid biopsies, circulating tumor cells and circulating tumor DNA, changing what we know about breast cancer?
Liquid biopsy involves using a blood test as a cancer diagnostic, prognostic, or predictive test. Liquid biopsy is increasingly being used in clinical trials as an indicator of whether treatment with a particular therapy is associated with a blood test result that can help guide treatment. Liquid biopsy testing is being used to determine if tumor DNA may be detected in the blood as a potential sign of disease recurrence even before it can be detected by x-ray scans. In some cases, liquid biopsy is used to tell us more about the tumor’s biology, such as what is the tumor tissue of origin in cases where this is unclear.
You specialize in inflammatory breast cancer. What are researchers learning about this aggressive form of the disease, and how could that research improve treatment?
Inflammatory breast cancer is one of the most aggressive forms of breast cancer, and one of the things we’re learning is that its behavior is driven not just by the cancer cells themselves, but by the environment around those cells. Researchers are using technologies like single-cell sequencing and spatial analysis to look at individual cancer cells and the immune cells around them. Researchers are learning that inflammatory breast cancer can create an environment that helps the cancer cells evade the immune system. Scientists are also studying the tumor cells that form clusters, or tumor emboli, within the lymphatic vessels of the skin, which is one of the features that makes this cancer so distinctive. The goal is to take that biological information and turn it into better treatment. Rather than treating every patient the same way, we want to identify which pathways are driving an individual patient’s cancer and then target those pathways – potentially combining chemotherapy, targeted therapies, immunotherapy and other treatments in a much more precise way. My lab (and others) have focused on developing better models to study inflammatory breast cancer so that we can test combinations of therapies to improve outcomes.
How does being a surgeon and physician researcher shape the way you approach your work and care for patients?
Being both a surgeon and a physician researcher shapes my work in two complementary ways. As a surgeon, I care for patients at some of the most vulnerable times in their lives. That experience keeps me focused on the individual – not just the diagnosis, the imaging or the pathology, but the person behind them. I want my patients to understand their options, feel heard and know that we are making decisions together.
As a researcher, I am constantly asking questions. Why did this cancer behave so aggressively? Why does one patient respond well to treatment while another does not? How can we use what we have learned in the laboratory to improve outcomes for patients in the clinic?
Being both a surgeon and a researcher allows me to connect those two worlds. The patients that I care for help shape the questions we pursue in research, and the discoveries we make in the laboratory can ultimately lead to more precise and effective treatments. It also gives me deep appreciation of translating research into care that is meaningful for patients.
Ultimately, my goal is to combine scientific curiosity with compassion. I want to offer patients the best treatment available today while also working to develop better treatments for tomorrow.
What promising area of breast cancer research excites you most right now, and what gives you hope for the future?
What excites me the most right now is how much more precisely we’re able to understand an individual patient’s cancer. We’re moving away from treating breast cancer simply by what it looks like under the microscope and toward understanding the biology of each tumor – and then using that information to choose the right treatment for that particular patient.
As a member of ICRF’s Scientific Review Panel, what excites you about the cancer research being conducted by scientists in Israel?
One of the things that excites me most, as a member of ICRF’s Scientific Review Panel, is the creativity and boldness of the science coming out of Israel. When I review these applications, I’m struck by how often researchers are asking fundamental questions about why cancer develops, why it spreads, and why some patients respond to treatments while others don’t – and then finding very innovative ways to answer those questions.
There is particularly exciting work in precision medicine, immunotherapy, liquid biopsies, artificial intelligence, single-cell biology, and understanding the tumor microenvironment. Those areas are converging in ways that could allow us to detect cancer earlier, understand a tumor at a much deeper level, and ultimately match patients with treatments much more precisely.
Learn more about ICRF’s scientific review process.
