This was my first trip to the San Antonio Breast Cancer Symposium, and I admit to feeling overwhelmed. So many presentations, so many posters, so much bad food. When I tried to sort it all out, make sense of all that had been said, I realized the bottom line was this: There is no cure for breast cancer, it doesn’t appear there will be one any time soon, and the most logical thing to do now is treat it as a chronic disease.

During the presentation on the ATAC trial, the presenter referred to a group of sheep that lives off the northeast coast of Scotland, on an island called North Ronaldsay. These sheep were exiled to the island’s beaches in the 1800s, when ranchers decided the land was better suited for cattle grazing. The sheep did not die after being removed from their natural habitat, but adapted. They began eating the kelp along the shore and not only survived, but thrived, and can still be found on the rocky shores of North Ronaldsay. The presenter described this phenomenon as “fast-track adaptation in the face of adversity,” and speculated that this same adaptation could explain the survival of HER2-positive, estrogen-receptor-positive tumors treated with anastrozole and tamoxifen.

What I’m wondering though, is if everyone involved in the “war on cancer” is also adapting in the face of adversity, and having decided that breast cancer is incurable, are they now proceeding with the premise that it is a disease we have to live with, or too often, die of?

It’s disheartening, but given the history of this disease and the number of failed “breakthroughs,” not surprising. What makes the picture less bleak, at least for me, was the dedication, sensitivity and care displayed by the clinicians and advocates who were present. There may not be a cure, but it’s not for lack of trying.

One of the bright spots was the nightly advocate meetings, during which researchers discussed what they found most interesting about the day’s presentations and then took questions from the advocates. I expected tense interactions, but was pleasantly surprised at the mutual respect shown, and the intelligence of the discourse. A highlight was Dr. Susan Love, funny and engaging, who spoke about the need to look beyond the tumors and focus on the “stroma,” or, as she called it, the “neighborhood,” the tumor is living in, for clues on how to treat the disease.

Another bright spot was Dr. Charles Loprinzi’s presentation on symptom management in breast cancer survivors. He noted that more cancer patients are living longer, which means more treatments and more toxicities. Pointing to fatigue as a common side effect of treatment, he noted that both exercise and ginseng appear to be effective in counteracting fatigue. It was refreshing to hear about two treatments that weren’t pharmaceutical.

And speaking of big pharma, well, let’s just say they were everywhere. If there was ever any doubt in my mind that breast cancer is big business, it was certainly erased by this symposium. There are an awful lot of people making a living on this deadly disease.