On The Frontline

October is BREAST CANCER AWARENESS month and new research is driving improvements in treatment …

M BRAGA / FIGAROPHOTO / CAMERA PRESS

CHECKS AND BALANCES

The recent cervical cancer debacle has rocked our confidence in national screening programmes, though the most vocal champions of the programmes are those brave victims themselves. When it comes to breast cancer, it may comfort you to know that BreastCheck has been accredited three times by international experts, most recently this year, when it achieved the highest level of accreditation from the European Reference Organisation for Quality Assured Breast Screening and Diagnostic Services (EUREF) as a European Reference Centre for Breast Screening. EUREF is a pan-European non-profit organisation, that develops evidence-based guidelines for best clinical practice and quality assurance of breast cancer screening and diagnostic services in cooperation with the European Commission. Certification involves rigorous analysis of breast screening performance data and includes external audit of all clinical specialties through site visits by a team of expert clinical auditors. Achievement of certification recognises and guarantees quality conformance of the clinical and technical aspects of breast cancer screening, diagnosis and treatment, data collection and epidemiology. Following BreastCheck’s certification visit, EUREF said they observed a “commendable standard of professional activity, with excellent and well trained multi-disciplinary clinical teams operating to international standards and with all professional staff showing good team dynamics.” If you are over 50, you should have a free mammogram every two years. Check you’re on the register at www.breastcheck.ie.

BREAST PREDICT MAKS ITS FIFTH ANNIVERSARY

The best breast cancer outcomes result from the most personalised, targeted treatment plans. This month marks the five-year anniversary of the Irish Cancer Society Collaborative Cancer Research Centre Breast-Predict, which brings together experts – surgeons, oncologists, clinical researchers – from all over Ireland to tackle challenges facing breast cancer patients and their doctors. Gathering and analysing samples of tumour tissue and blood, along with lifestyle information, from hundreds of Irish women with breast cancer in the National Breast Cancer Biobank and Database, has allowed researchers to better understand the disease and develop new and better therapies. Looking at the medical records of these patients prior to and post diagnosis allows researchers to understand if “ordinary” medication, like aspirin and statins, taken prior to and after diagnosis, had any effect on a patient’s outcome. The Centre also studies how tumour cells change and adapt over time and become resistant to treatment, and research seeks to target “weak spots” in breast cancers which can be targeted with new drugs or more effective combinations of existing drugs. Breast-Predict includes researchers from six academic institutions across Ireland: UCD, RCSI, TCD, DCU, NUIG and UCC, and a nationwide clinical trials group, Cancer Trials Ireland. To learn more or donate, see www.breastpredict.com.

NO NEED FOR CHEMO?

A recent study suggests that chemotherapy treatments – once thought to be a frontline necessity in the battle against tumours – are unnecessary for many women with breast cancer, especially those over 50 with early-stage disease. Findings from the groundbreaking TAILORx trial, show that about 70 per cent of women with breast cancer can avoid toxic chemo after surgery, treating their disease with hormone therapy. The new findings relied on gene tests that give women with breast cancer a highly nuanced score, which allows doctors devise an individualised post-operative treatment plan. One genomic test, called Oncotype DX (costly but often covered by insurance), measures the function of 21 genes in a tumour (removed via lumpectomy or mastectomy) to give a score from 0 to 100. Women with low scores of 0 to 10 need only rely on endocrine therapy to stop the growth of their cancer, while those with scores above 25 could improve their prognosis by adding chemotherapy to their treatment. A study of more than 10,000 randomised patients revealed survival rates of nearly 95 per cent using endocrine therapy alone. Skipping unnecessary chemo means women can avoid the emotional and physical toll and potential longterm side effects.

Suitable candidates with hormone-receptor-positive cancer that is HER2-negative (meaning there is little or no human epidermal growth factor), and whose lymph nodes are cancer-free, benefit most. For younger women, traditional protocols may still be the best course of action. Experts agree that the implications of gene testing and precision medicine offer great hope for breast cancer sufferers.

A NEW TREATMENT FOR TRIPLE NEGATIVE CANCER

Scientists in Britain have expressed optimism for women with hard-to-treat breast cancer after a new chemotherapy regime proved it can shrink tumours twice as fast as normal methods. Women with aggressive “triple-negative” disease fare much better on a non- standard chemotherapy drug if they have inherited BRCA gene mutations, the results of a trial showed. Currently most patients with this type of breast cancer, which does not respond to hormone therapies or the targeted drug Herceptin, are treated with the chemotherapy agent docetaxel. But the new trial findings show that those with defective versions of the genes BRCA1 or BRCA2 are much more likely to benefit from a different drug, carboplatin.

A total of 376 women with advanced triple-negative breast cancer took part in the trial, including 43 who had BRCA gene faults. Among the BRCA mutation carriers, carboplatin shrank tumours in 68 per cent of cases, while docetaxel only had a 33 per cent success rate. Carboplatin also produced fewer side-effects and delayed tumour progression for months longer in women with BRCA mutations. The results are likely to change international guidelines by introducing genetic testing for women with triple-negative breast cancer.

Lead researcher Andrew Tutt, Professor of Breast Oncology at The Institute of Cancer Research in the UK, said: “Our study has found that women with triple-negative breast cancer who have BRCA1 or 2 mutations are twice as likely to respond to carboplatin as they are to standard treatment. “It strongly suggests that many women with triple-negative breast cancer should be considered for testing for faults in the BRCA genes so those who test positive can benefit from carboplatin. For patients with inherited BRCA mutations, the drug carboplatin is not only a more effective treatment option, but also comes with fewer side-effects, sparing patients possible health problems, physical discomfort and emotional distress.” Fewer than ten per cent of breast cancers are caused by the faulty and hereditary BRCA1 and 2 genes. However, while the average woman has a twelve per cent chance of getting breast cancer before the age of 80, a study published by the Journal of the American Medical Association in 2017 found seven in ten of those with either gene will develop breast cancer. It also estimates over 40 per cent with BRCA1 and 20 per cent with BRCA2 will develop ovarian cancer.

EXTRA SCREENING IN SOME CASES?

Women with dense breasts  – those with more glandular tissue – could be six times more likely to develop breast cancer. At the same time, it can also be harder to detect tumours in dense breasts. Experts say up to half the cases of cancer in dense breasts could be missed via screening – tumours show up as white on a mammogram, but so does dense tissue, meaning that the cancer is missed in more than 50 per cent of cases. Further screening, like core biopsies and ultrasound, are important to those women at risk.

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