Walter Reed National Military Medical Center, BETHESDA, Md  –   The U.S. Navy’s highest-ranking officer was successfully treated for breast cancer earlier this year at the John P. Murtha Cancer Center (MCC) at Walter Reed National Military Medical Center.

Earlier this month, Adm. Lisa Franchetti wrote a letter expressing her gratitude for that care and encouraging others to be proactive in their health care.

U.S. Navy Cmdr. (Dr.) Matt Nealeigh, director of the Breast Care and Research Center at Walter Reed and one of Franchetti’s health care team members, read parts of the admiral’s letter during the MCC’s annual breast cancer summit, held Oct. 9 at the Uniformed Services University’s (USU) Sanford Auditorium.

Franchetti expressed her disappointment at not being able to attend the summit, explaining that her duties as the 33rd Chief of Naval Operations, the first woman to hold the position and the first woman to serve on the Joint Chiefs of Staff, had taken her out of the country. But she still wanted to thank the MCC staff for her care.

“As many of you know, I was diagnosed with breast cancer a few months ago and was recently declared cancer-free! I am grateful that my cancer was detected so early during a routine annual mammogram, and I am even more grateful to my amazing medical team at the John P. Murtha Cancer Center for the excellent care and development of my treatment plan,” Franchetti stated.

“I cannot advocate more strongly for routine screenings for all of our active and reserve Sailors, Navy civilians and their family members. It’s also important to encourage women of all ages to know their bodies and speak up if something seems wrong, and it’s on us as leaders to listen when they do. All of this will help in our battle against breast cancer,” Franchetti added.

The MCC at Walter Reed and MCC Research Program at the neighboring USU host the annual Breast Cancer Awareness Summit in October, which is Breast Cancer Awareness Month. As in past years, the summit focused on advances made in research and care during the past year. This year’s summit focused specifically on metastatic breast cancer, also called metastases, or the spread of the cancer from the breast to other areas within the body.

“[Metastatic breast cancer] was, for a long time, really kind of a death sentence,” Nealeigh said. “You had metastatic breast cancer and you started preparing your affairs, so to speak. For breast cancer especially, it is not that anymore. There are some patients who have a very limited prognosis, [and] there are some who have a very lengthy and good prognosis, and they will end up living with disease, but more importantly, living in spite of disease for a long time,” he added. He explained that an excellent quality of life is achievable for many of these patients because of various modalities.

“Even as we understand that breast cancer survival has increased, there are still many, many challenges in terms of findings of diagnosis in younger women, with specific demographics being affected,” said Dr. Jonathan Woodson, USU president. He added this is very important for members of the military community, and also vital for continued collaboration with the U.S. Department of Veterans Affairs (VA) for extended care. He also praised “the tremendous work” that has come out of the MCC since it was officially established in December 2012, operating jointly between Walter Reed and USU to support the clinical, educational and research aspects of cancer care throughout the Department of Defense as DOD’s only Cancer Center of Excellence.

The MCC also partners with the National Cancer Institute (NCI), and Dr. Stan Lipkowitz, chief of NCI’s Women’s Malignancies Branch, discussed updates from the institute concerning metastatic breast cancer. He explained that one of the challenges with metastatic breast cancer, especially HER2+ breast cancer, are brain metastases. In addressing new and future systemic treatments for metastatic breast cancer, including endocrine therapy, immunotherapy, chemotherapy, and other treatments, Lipkowitz described ongoing research involving AI, algorithms, and gene, cellular, and molecular therapies, inhibitors, as well as protein activators to disrupt cells likely to cause cancer tumors.

Dr. Tracy-Ann Moo, associate attending surgeon at Memorial Sloan Kettering Cancer Center in New York, discussed the role of surgery in metastatic breast cancer. She pointed out that breast cancer is the most common cancer in women, and death rates from the disease have fallen since the 1980s because of advances in research and enhanced therapies. In 1975, there were about 31 deaths out of 100,000 women with breast cancer. According to federal government statistics, that number fell to approximately 19 deaths out of 100,000 by 2022. Estimated new cases of breast cancer in 2024 are projected to be approximately 311,000, and estimated deaths from the disease are projected to be about 42,000 (or roughly13.5 percent), according to the federal government’s Surveillance, Epidemiology, and End Results (SEER).

Routine surgical treatment of the primary tumor for metastatic breast cancer does not necessarily improve overall survival, [but] may improve locoregional progression-free survival,” said Moo. She added that the impact of surgical treatment of the primary tumor for metastatic breast cancer on quality of life is unclear.

“Up to 20 percent of patients with metastatic breast cancer may require locoregional therapy for palliation. Ongoing research [into surgery for metastatic breast cancer] is needed as systemic therapies continue to improve,” Moo added. “I tend to use surgery as a last resort,” she shared. “It’s case by case,” said Lipkowitz.

U.S. Navy Cmdr. (Dr.) Anna Torgeson, a radiation oncologist at Walter Reed, addressed, “Beyond Palliation: The Role for Radiotherapy in Metastatic Breast Cancer,” stating, “Patients are living longer [because of] increasingly effective and durable systemic treatment.” She said this could mean, “Local control matters more [in treating breast cancer]. The question is, ‘How do we get there?’,” she added.

“In the radiation and oncology world, we have advanced imaging and treatment techniques that allow for increased efficacy, safety and tolerance of treatment,” Torgeson added.

Retired U.S. Army Col. (Dr.) Rick Stocker, clinical lead for Nuclear Medicine and Molecular Imaging Service at Walter Reed, closed out the summit discussing estrogen receptor (ER)-targeted PET imaging in assessing lesions that are difficult to biopsy.

“The National Comprehensive Cancer Network (NCCN) recommends receptor status testing in all patients with primary and recurrent breast cancer,” Stocker said. He explained that over the past few years, there have been a number of technological advances in imaging. About two of every three breast cancer cases are hormone receptor-positive, many of which are estrogen receptor (ER) positive, often responding well to hormone therapy depending on the severity and extent at diagnosis.

Stocker explained the FDA-recently approved (ER)-targeted PET imaging has helped better detect breast cancer because, unlike traditional imaging methods that rely on blood flow to a specific area to create a contrast-enhanced image or cellular metabolism for a scan, (ER)-targeted imaging uses the hormone receptors on the surface of the cells for localization. This allows the medical team to visualize where the ER-positive breast cancer is within the patient, regardless of location.

In addition to doing monthly self-exams, women should have routine mammograms, health providers stress. All women should have a risk assessment by age 30. As of April 30, 2024, the U. S. Preventive Services Task Force (USPSTF) recommends that all women at average risk of breast cancer get a mammogram every other year starting at age 40 and continuing through age 74. Women with a strong family history of breast cancer or genetic mutation may benefit from starting screening earlier than age 40, according to the USPSTF. Men should start screening at age 50 or 10 years before the earliest known male breast cancer diagnosis in their family, whichever comes first.

For more information concerning breast cancer, visit the Centers for Disease and Prevention Control (CDC) website at https://www.cdc.gov/breast-cancer/index.html.