Seeing What Survives: Why Some Breast Cancer Cells Persist
For a woman who has survived breast cancer, survival means moving forward. For cancer cells that survive treatment, it means the possibility that the disease will return.
Why do some cancer cells persist? Could understanding them lead to more effective
treatment, less uncertainty, and fewer unnecessary interventions?
For breast cancer survivor and research advocate Eva May, these questions are personal. Drawing on her background in human-centered design, she helps the Lineberger Breast Cancer SPORE team incorporate patients’ priorities and experiences into research.
May wants research participants to feel “like they are stakeholders in the success of the research, and partners in the attainment of the goals.”
This philosophy also underpins Ramanujam's work through the Department of Defense Breast Cancer Research Program's Innovator Award, which brings together cancer biologists, engineers, oncologists, surgeons, and patient advocates to approach breast cancer from different perspectives. Together, they aim to turn a deeper understanding of the disease into better care for the women whose lives it affects.
Why Does Cancer Return?
Tumor shrinkage does not always mean every cancer cell is gone. What allows some cells to withstand treatment and fuel recurrence?
Andrei Goga, a physician-scientist at the University of California, San Francisco, studies this question in experimental breast cancer models. His group has found that some tumors driven by the MYC oncogene, which is common in Triple Negative Breast Cancers depend on fat metabolism, and their nutrient needs vary with treatment and could reveal vulnerabilities.
According to Goga, “That’s really where our work with Nimmi has come in, to see what happens when we turn off the cancer genes that drive those tumors and see what happens to the metabolism in those cancers.”
Molecular studies identify cancer-related genes and pathways. Metabolic measurements reveal how surviving cells use nutrients and adapt during treatment.
Making Cancer's Changing Behavior Visible
At Duke’s Center for Global Women’s Health Technologies (GWHT), Nimmi Ramanujam’s team uses optical imaging to reveal how breast cancer cells use glucose, fats, and energy as tumors respond to treatment. Their studies in mice show that metabolism changes as cancer persists and regrows, with different regions of the same tumor behaving differently, offering new clues to why some cells survive.
Megan Madonna, GWHT’s assistant director of education and an assistant research professor at Duke, studies these differences, known as heterogeneity. “Our engineering tools brought this heterogeneity into the spotlight,” she explained.
Together, Goga’s models and GWHT’s imaging connect possible survival mechanisms with observable changes.
“We often judge cancer treatment by whether a tumor shrinks. But understanding which cells survive and why is just as important. Bringing biologists, engineers, and clinicians together could turn that knowledge into better treatments for women,” said Ramanujam.
Cancer-cell survival is only part of the challenge. What about the immune cells that fight cancer?
Melissa Skala, a biomedical engineering professor at the University of Wisconsin–Madison and former student of Ramanujam, studies how T-cell metabolism could improve immunotherapy.
“Studies suggest that altering T-cell metabolism could enhance immunotherapy and improve patient outcomes,” Skala explained.
From Laboratory Measurements to Treatment Decisions
Graduate student Katie Broun is testing GWHT’s imaging in three-dimensional tumor cultures with Jennifer Rosenbluth, a breast medical oncologist and investigator at the University of California, San Francisco.
“We are trying to determine whether we can get an early readout of whether cancer therapies are working or not for an individual tumor,” Rosenbluth explained.
The work aligns with the I-SPY trials, which investigate tailoring breast cancer treatment using tumor biology and early response. Molecular measurements characterize cancer pathways; metabolic imaging could add information about changing nutrient use to ultimately inform clinical decisions.
Broun describes the value of that collaboration: “By their building of biology and our building of tools we’re able to answer some really interesting questions together,” she said.
Duke undergraduate Adelle Yong, whose mother experienced recurrent breast cancer, was inspired by her family’s experience to pursue breast cancer research at GWHT.
But when is an early signal reliable enough to guide treatment? Duke breast oncologist Alexandra Thomas, who has worked on I-SPY trials, often brings clinical questions back to researchers: “I’m seeing this in the clinic…it doesn’t make sense. Can you help me understand this?” For Thomas, new measurements must lead to decisions that genuinely benefit patients.
Back to the Patient
For women with breast cancer, the goal is better treatment, less uncertainty, and improved quality of life. Eva May emphasizes that patients should help shape research from the outset, defining what matters most while ensuring participation is accessible, inclusive, and respectful of their time. “Developing a protocol that reduces participant burden to the extent possible, taking advantage of tools and technology that allows participants to participate remotely and on their own schedules.” Her point underscores the larger purpose of this work: advancing breast cancer research means not only understanding the disease but also listening to patients and designing better care around their needs.
Featured GWHT Collaborators
