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To find answers in breast cancer, Dr. Ron Johnson listens to the patients

In the 30 years that Dr. Ron Johnson has been a breast cancer surgeon at UPMC Magee-Womens Hospital and UPMC Hillman Cancer Center, treatment for patients has changed dramatically. And for that, he gives much of the credit to the patients themselves.

“Virtually every question in breast cancer care has been answered not by doctors, but by patients — patients who had the courage, when the answer wasn’t known, to participate in clinical trials so that we could get the answer,” he says. “And therefore, they benefited the generation that came after them.”

Listening to the patients has been instrumental in the evolution of breast cancer treatment, he notes.

“If you’re going to be good at bringing about change in the way people are treated, the first step is always to listen to patients and find out what’s important to them,” Dr. Johnson says, pointing out that the journey from total mastectomy to far less invasive surgeries has been driven by patients who wanted to be cured of their disease, but also to return to their lives as functionally as possible.

Those desires led to lumpectomies instead of mastectomies, then smaller lumpectomies, and may one day eliminate the need for surgery altogether in women who respond to targeted treatments — a concept that doctors and patients are currently exploring through clinical trial.

“The women who are participating in that trial are going to be heroes in another generation,” he says. “It’s just a classic example of how we build on the next breast cancer question by answering the last one. It’s Legos, building blocks.”

Today, the trend in research seems to point to more personalized medicine based on how the disease behaves in each individual patient. This strategy eliminates therapies that have no benefit in certain women and focuses on targeted treatment based on individual patients’ tumor characteristics.

“If anyone were to ask me: ‘Do you think this is what breast cancer treatment would have looked like when you first started 30 years ago?’ I’d have to admit it’s nothing like I would have guessed,” Dr. Johnson says. “It’d be the equivalent of saying, ‘What do you think high definition television is going to look like 20 years from now?’ and none of us can imagine.”

But he does have some hunches.

“Clearly, the path that we’re on now is to treat every single person who’s diagnosed with breast cancer differently than the last one,” he says. “So I imagine that 20 years from now, no two breast cancer patients will be treated in an identical fashion because the care for each one of them will be individualized.”

For that to happen, support for research is absolutely critical, he notes.

“When you support breast cancer research, what you’re really doing is supporting uncertainty,” Dr. Johnson says. “It’s that uncertainty about: ‘Do I have the opportunity to literally change the future? Do I have the opportunity to make sure that my child, who is 10, doesn’t have to worry that her unborn daughter will be put in a horrible position by this disease?’”

He hopes the answer is yes.

“If the past is any indication of the future, the treatment of breast cancer will evolve over the next 30 years to something that patients and physicians dealing with and caring for the disease today would find unrecognizable”, he says. “That includes the potential for eliminating the need for treatment altogether with better understanding of preventative measures.”