Now a UCSF study could have a dramatic effect on breast cancer treatment.
San Francisco school teacher Jane Ardito is on the front line of the battle against breast cancer. But when she was diagnosed, she didn't rush into surgery.
Instead, she volunteered for a clinical trial that turned older treatment procedures for her type of tumor, upside down.
"It still involved chemotherapy, radiation and surgery, but in a different order," said Ardito.
"So instead of starting with surgery, we start with chemotherapy, or systemic therapy," said UCSF surgeon Dr. Laura Esserman.
Dr. Esserman is helping to lead a nationwide research project to fast track new treatments for the deadliest forms of breast cancer. It's called I-Spy.
"Breast cancer is complicated because it's not one disease. So we want to understand the different types of breast cancers that people show up with, so we can get prepared to start to treat them differently," said Dr. Esserman.
First, researchers perform intensive imaging scans and molecular tests to more precisely identify the characteristics of a tumor.
Depending on the diagnosis, patients like Jane can be treated with emerging cancer drugs, leaving radiation and potential surgery to follow.
"We need solutions for those who are at the most risk of dying, so what we've done now is said ok, when these women come in, we're going to get some of these new agents that are targeting specific tumor types and add that to the chemotherapy. And we're going to learn as we go how these treatments are working," said Dr. Esserman.
The strategy is part of a larger rethinking about the treatment of breast cancer. In November, a government panel touched off a national controversy by questioning the need for women in their 40s to have regular breast screening.
Part of the argument is that a mammography in younger women could lead to a higher rate of false positives. It can also lead to the discovery of cells which may never progress to cancer, while the deadliest tumors known locally as advanced breast cancer develop so quickly, they often appear in between scheduled screenings.
The real challenge, according to many researchers, is finding new combination of drugs and therapies to stop the spread of those cancers.
"If cancer spreads to other parts of the body, that's what kills someone. So surgery isn't what cures somebody, it's whether you have systemic therapy that will prevent those cancer cells from going elsewhere," said Dr. Esserman.
She says I-Spy trials have already identified certain biomarkers linked to aggressive cancers.
The next phase is aimed at cutting the time it takes to analyze new cancer drugs from years to months.
Jane sees her decision to participate in the study, and receive drug treatment first, as a victory in the war against her disease.
"The tumor shrunk, then I had surgery, which was much less than we anticipated, as far as I'm concerned it was a complete success," she said.
Dr. Esserman's team is also involved in a program that links breast cancer patients to clinical trials that might offer more hope.