Rethinking Breast Cancer

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Herceptin is only a beginning, says UCLA's Slamon, who identified the HER2 receptor. There are bound to be other cancer proteins that pharmaceutical manufacturers can use as targets as they develop new, more selective drugs. "Using a combination of [these kinds of] therapies earlier in the disease could have a dramatic impact on outcomes," Slamon says.

It might also lay to rest any debate over the benefits of mammography; in the final analysis, early detection is only as good as the treatments that follow. You want to know which women's lives will be saved by surgery, radiation, chemotherapy or hormone treatment. Otherwise, you risk doing more harm than good.

That's why it helps, when trying to sort through the current unsettled state of affairs in breast cancer, to take the long view. "There's always a trend or an issue that everyone's chasing after," says Fran Visco, president of the National Breast Cancer Coalition. "I do think we're at a place where we can begin asking some of those questions regarding targeted therapy. But I don't think we're going to get the answers next month or next year."

In the meantime, women like Nancy Ulene who discover they have breast cancer have to decide what to do with their lives and their breasts based on information currently available. There are days when many women would probably agree with Ulene's assessment that it's all a "crapshoot" anyway. After much soul-searching, she finally opted for a partial mastectomy and tamoxifen. It may not happen today. It may not happen tomorrow. But eventually those decisions will start to get easier.

--Reported by Janice M. Horowitz, Alice Park and Sora Song/New York and Jeanne McDowell/Los Angeles

FOR MORE INFORMATION The National Cancer Institute's hot line at 1-800-4-CANCER can answer questions about cancer diagnosis and treatment and offer tips for preventing breast cancer. On the Web, visit www.cancer.gov