From mammograms to microbiomes | News

Every October, the familiar pink ribbons return to storefronts, fundraisers and advertising campaigns, signaling Breast Cancer Awareness Month. For many women, it is a reminder to schedule mammograms (earlier now — starting at age 40) and to honor those touched by the disease.

Yet for researchers in Southern Arizona, breast cancer awareness is only the starting point. New trials, innovative diagnostics and emerging therapies are reshaping how women receive medical treatment, while broader issues such as endometrial cancer, menopause and equity in access to care demand equal attention.

Dr. Sima Ehsani Chimeh, a breast oncologist and member of the University of Arizona Cancer Center’s clinical research team, sees firsthand how quickly the landscape is changing. 

“We have clinical trials in both early-stage and late-stage breast cancer,” she said during a recent dinner break on a full clinic day. “We usually classify these into three groups: hormone receptor–positive cancers, HER2-positive cancers, and triple-negative cancers. Each group has trials for early stage as well as stage IV disease.”

The jargon may go over the heads of many of us, but for women already navigating treatment — where acronyms like ER+, HER2 and ctDNA have forced their way into everyday language — her words are encouraging.

“For early-stage or locally advanced HER2-positive breast cancer, we’re running a vaccine study,” she said. Patients who receive chemotherapy before surgery and still have high-risk residual disease may be eligible for the trial, which uses an anti-HER2 vaccine. “In advanced HER2-positive disease, we have a study testing a new antibody plus chemotherapy, and another looking at cell-based immunotherapy combined with chemo for patients with refractory disease,” she added.

Those kinds of innovations are part of a broader shift toward precision medicine. “For hormone receptor-positive disease, we have trials focused on cancers that become resistant to standard therapies,” she said. “We’re targeting specific mutations that drive resistance, and tailoring treatment accordingly. There’s also a trial combining chemotherapy and immunotherapy for higher-risk early-stage cases.”

Ehsani Chimeh, who also works with the Phase I clinical team, said molecular testing is increasingly central to patient care. “These studies use molecular testing of tumors to identify mutations, and then we match patients to drugs in early development. It’s precision medicine in action.”

New directions in research

While much of her work involves clinical trials already available to patients, Ehsani Chimeh said the Cancer Center is also investing in earlier-stage research with long-term potential. She pointed to new funding the center received in August for a preclinical study using radioligands — an approach known as theranostics. 

“The idea is to diagnose HER2-positive cancer through imaging, like a PET scan, and then deliver targeted radiation directly to those cancer cells,” she explained. “It’s being used in prostate cancer but not yet in breast cancer. If it works, it could let us treat with much more precision while sparing healthy tissue.”

Ehsani Chimeh said the prospect of theranostics illustrates how rapidly the field is evolving. “If this is successful in the future, even in early-stage breast cancer where        the cancer might be microscopically spreading, we could find those areas with imaging and treat them locally with targeted radiotherapy. That’s how we think we can treat cancer with more precision.”

Inclusion and equity in Southern Arizona

Ehsani Chimeh emphasized that expanding access to these innovations is just as important as developing them. “There are disparities in cancer care,” she said. “Triple-negative breast cancer, for example, is more common among patients of African descent. Here in Arizona, we’re also focusing on Hispanic and Native American populations.”

Southern Arizona’s diversity, she added, is actually a strength for research. “Many of our trials are multi-institutional, and one of the pluses we have here is the diverse community,” she said. “It’s very important for all of these studies to be more inclusive and bring in patients from different backgrounds.”

Practical steps are being taken to ensure that inclusivity. “The first thing we ask is to have Spanish-language consent forms and materials from the start,” she said. “The Cancer Center is also hiring study navigators to help patients understand trials, answer questions and guide them through the process. And many of our research nurses and coordinators are bilingual, which makes a big difference.”

The importance of screening

The preventive side of care remains critical. With the U.S. Preventive Services Task Force now recommending mammograms starting at age 40, Ehsani Chimeh said the change is welcome. “We always recommended screening mammograms to begin at age 40,” she said, noting that other medical organizations had long supported that guideline. “Now that USPSTF also recognizes this, more patients can start earlier, and that will help us catch more cancers at a treatable stage.”

Still, barriers remain. 

“One challenge we face in Southern Arizona is the belief that if you don’t have symptoms, you don’t need a mammogram,” she said. “Screening is done when women don’t have symptoms. That’s how we make earlier diagnoses and improve outcomes.”

Ehsani Chimeh said the progress in treatment has been striking. “If you look at the data on survival from breast cancer in the past 50 years, it’s constantly improving every year,” she said. “The mortality rate has been decreasing because treatments have become more precise and more effective. We have many new drugs in development, and it’s very important to keep opening and joining clinical trials so we can continue making progress.”

Beyond breast cancer: Other women’s health challenges

While breast cancer dominates October headlines, World Menopause Day is also held every year on Oct. 18th, demanding attention as well. Even the consumer market is beginning to respond, with new products — like Dove’s recently launched Women’s Wellness Collection — aimed at addressing issues linked to menopause and sensitive skin. Products like a glycolic serum body wash, which other beauty products makers are already following Dove’s lead on, signal how the market is beginning to acknowledge menopause-related changes in skin health.

At the University of Arizona College of Medicine–Phoenix, Dr. Melissa M. Herbst-Kralovetz leads a translational women’s health research program focused on the vaginal microbiome — the community of bacteria that plays a crucial role in gynecologic health.

“The vaginal microbiome is tied directly to women’s health,” she said. “When lactobacillus species dominate, they create positive outcomes. But when they’re depleted and replaced with other bacteria, called dysbiosis, inflammation increases. That can contribute to infections like HPV, which promotes cervical cancer — and may also influence endometrial cancer.”

Endometrial cancer, she noted, is one of the fastest-growing challenges. “It’s the only major cancer type that’s actually increasing,” she said. “It’s now the most common gynecologic cancer, and we’re seeing it skyrocket — linked to obesity and metabolic syndrome. In Arizona, Latinas and Native American women are disproportionately impacted and usually present later, with poorer outcomes.”

Reducing barriers through innovation

Herbst-Kralovetz, recently recognized by the Arizona Bioindustry Association as Biosciences Researcher of the Year, said her lab is developing noninvasive diagnostic tools to empower women and close gaps in access. 

“One of the barriers is how invasive diagnosis is for endometrial cancer,” she said. “We’re working on vaginal swab tests that women could use at home or in the clinic. That kind of test could empower women, close care gaps and detect early warning signs before invasive biopsies are needed.”

Beyond detection, the goal is prevention. “We’re going to see more interventions that modulate the microbiome,” she said. “Vaginally applied probiotics or microbiome-targeted therapies could restore healthy lactobacilli and reduce risk, potentially preventing cancer altogether.”

Menopause and midlife medicine

The microbiome also shifts during menopause, Herbst-Kralovetz said, with estrogen loss contributing to dysbiosis. “When estrogen goes down, those bacteria go down too,” she said. “That can impact sexual health and overall well-being. The good news is, when you restore estrogen through hormone replacement, you restore the microbiome balance as well.”

She added that research funding is finally beginning to reflect this need. “For many years, NIH and others were mostly concerned with reproductive health and the premenopausal stage,” she said. “Now we’re starting to see a shift, with more attention and funding for menopause research. That’s going to make life easier for women struggling with symptoms.”

Clinics in Tucson are responding, with both conventional and integrative approaches. Banner-University Medicine’s Women’s Wellness Clinic is tailoring hormone therapy with lower-dose and transdermal options, while practices such as Tula Wellness, led by Dr. Arianna Sholes-Douglas, combine gynecology with nutrition and lifestyle counseling. The result is a more personalized set of tools for women navigating perimenopause and menopause.

A “moment” for women’s health

Herbst-Kralovetz believes it is an exciting time for women’s health innovation. 

“Women’s health is finally having a moment,” she said. “We’re seeing innovation not just in the lab, but in the clinic and even in the design of medical devices. It’s an exciting time, because for once, women’s needs are driving the change.”

From Ehsani Chimeh’s work in breast cancer trials to Herbst-Kralovetz’s research on endometrial cancer and menopause, the message is clear — the conversation about women’s wellness must go beyond a single month or disease. In Southern Arizona, that conversation is already underway, with researchers and clinicians reimagining how women are diagnosed, treated and supported throughout their lives.

“Women deserve better,” said Herbst-Kralovetz. “We’re finally seeing innovation and what we call ‘Femtech’ being developed now, and that’s moving the needle for women.”