Breast Health

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Frances Quinn, Great British Bake Off winner, “I am proud to support Breast Cancer Haven”

WOMEN WITH

metastatic breast cancer deserve better.

P4 NEW TREATMENT

for cancer may mean fewer side effects.

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PHOTO: JAMIE LAU

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Determined to live life to the full after being diagnosed with breast cancer.

P4

Extended online Read more about the work Frances Quinn does with Breast Cancer Haven ONLINE

World Cancer Research Fund on how eating well can help cancer patients manage treatment ONLINE

The future of breast cancer is down to you, too

With breast cancer still cutting short over 11,500 lives each year, we urgently need to raise awareness of what women can do to reduce their risk.

B

reast cancer remains the most common cancer in the UK. Thanks to research progress, more women are surviving – in spite of the fact that more are being diagnosed than ever before.

If we all act now, we believe that by 2050, everyone who develops breast cancer will live – and will live well. While Breast Cancer Now continues to fund research to prevent, detect and treat the disease better, we’re also encouraging people across the UK to play their own part.

Over 50,000 women are diagnosed with the disease each year, most Follow us

after spotting a sign or symptom and getting it checked by their GP, but less than half of women in the UK check their breasts regularly and we continue to lag behind other European countries on early detection.

Breast cancer is at a tipping point and we need to take action. If we can help more women know how to be breast aware, and encourage more to attend screening when invited, many more lives could be saved.

That’s why we’re encouraging all women to Touch Look Check: get to know what looks and feels normal for you, check regularly and report anything unusual to your doctor.

Because, whether it’s a lump, nipple

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@MediaplanetUK

Baroness Delyth Morgan Chief Executive, Breast Cancer Now

discharge or a change in shape that’s spotted first, the earlier breast cancer is diagnosed, the better the chance of successful treatment.

What can we all do to reduce our risk? There are some factors we can’t change, like our age. But if, as a nation, we can get our pulses racing daily, maintain a healthy weight and cut down the amount of alcohol we drink, we can make a real difference to the number of us going through this devastating disease.

To find out more about breast checking, screening and reducing your risk of breast cancer, visit breastcancernow.org/tlc @MediaplanetUK

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Precision medicine has breast cancer in its sights SPONSORED

Breast cancer survival continues to improve and, thanks to personalised treatment tests like Prosigna, fewer patients unnecessarily receive chemotherapy.

Achieving almost 80 per cent of breast cancer patients alive and disease-free 10 years after their diagnosis is an ‘astonishing achievement’ in the treatment of the disease. This according to Robert Stein, professor of breast oncology at University College London (UCL).

Stein attributes improved

outcomes to a range of factors, including greater public awareness and the introduction of drugs to prevent recurrence as a routine part of treatment.

“Developments have proved hugely successful,” says Stein. “The aim now is to make breast cancer treatment much more personalised.”

Prosigna (also known as PAM50) is a valuable diagnostic tool that accredited laboratories use to analyse an individual’s genes in order to determine the best treatment options for them based on their biological make-up.

A patient is given chemotherapy based on factors such as how aggressive their cancer is and whether it has spread to the lymph nodes. But not every breast cancer patient benefits from receiving chemotherapy, and the side effects of this treatment can be gruelling. Some patients receive far more benefit from hormone

therapies, meaning chemo could be completely avoided without reducing patient survival rates.

The type of precision medicine offered by tests like Prosigna gives doctors more accurate information on treatment suitability for the individual than that of traditional microscope diagnostics, and what Stein calls, ‘an historic, one-size-fits-all approach to treatment.’

A pioneering trial called Optima, the largest ever UK chemotherapy trial, is currently helping medical experts tailor their patients’ treatment using Prosigna.

Stein, who is overseeing the trial, says it could eventually mean bypassing chemotherapy in favour of hormone treatments in as many as two thirds of all breast cancer cases.

What’s more, the Prosigna test can be performed in UK laboratories, so precious tissue samples don’t need to be sent abroad for analysis (as is

currently the case). Testing in the UK wil also reduce the length of time it takes for patients to get results.

Research trials improve outcomes Dr Adrienne Morgan heads up the Independent Cancer Patients’ Voice charity and is a patient advocate for the OPTIMA trial. Diagnosed with breast cancer in 2005, Morgan says she “lost a year of her life” to chemo, which, for her, proved ineffective and still triggers side effects today.

Morgan’s cancer, which has now spread to her bones, wonders what the outcome of the disease might have been had she been given hormone treatment immediately. “Trials are the only way treatment improves,” she says.

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UK cancer patients first in Europe to benefit from new, tattoo-less surfaceguided radiation therapy (SGRT) SPONSORED

In 2017, 48 year-old Margarita from Nottinghamshire discovered a lump in her right breast whilst in the shower. Following a mammogram, she was told that she had cancer and would need to undergo an intense course of treatment, including a lumpectomy and radiotherapy – the latter typically involving permanent skin markings to help guide the radiation. Today, she has made a full recovery both physically and mentally, thanks to new technology that ensures a tattoo-less procedure for cancer patients.

Surface guided radiation therapy (SGRT) is not widely adopted in the UK, but is helping to make

radiotherapy treatments more accurate and improving current techniques by allowing alignment of patients without the use of tattoos.

It limits radiation being directed to healthy cells by monitoring the position of the body during delivery of the radiotherapy. Should a patient move during treatment, the system holds the beam ensuring no dose is delivered incorrectly.

For many women, radiotherapy tattoos are a constant and permanent reminder of their treatment and can be psychologically damaging*, however by using SGRT the practice of tattooing is eliminated.

Jacqui Dorney is the clinical lead at GenesisCare who is introducing this new technique to the UK. She says: “Avoiding visible tattoos has been shown to result in improved body image after breast cancer treatment so we are thrilled that we can now offer this to our patients to help them return to their everyday lives

Margarita Knibbs SGRT Patient

without a permanent reminder of their treatment.”

Jacqui adds: “Although the technique is available to treat all cancer types, this is also a particularly crucial method for left-sided breast cancer patients to ensure that no radiation is administered to the heart.”

Margarita was the first patient in Europe to receive the SGRT treatment using the tattoo-less approach and believes it has made a huge difference to her physical and psychological

recovery from breast cancer.

Margarita says: “I’d already had a lumpectomy on my right breast when I was transferred to GenesisCare to begin my course of radiotherapy. I’d heard that this usually involves permanent tattooing and was worried about this, as a tattoo would be another constant reminder of my cancer. So, when I heard I would be receiving SGRT I was incredibly relieved. My scars were already fading but a tattoo would have remained. “For me and I’m sure many women, I wanted to put the cancer behind me, so not having to look at a tattoo every day is a big positive. I couldn’t face looking at them every day, I just want to move on with my life”. * B. Clow & J. Allen Psychosocial Impacts of Radiation Tattooing For Breast Cancer Patients: A Critical Review (2010). Canadian Women Studies

genesiscare.co.uk

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A 360° look at metastatic

By Kate Sharma

The nurse:

The patient:

Having worked in breast care for over 17 years, Dr Victoria Harmer, Macmillan Consultant Nurse at Imperial College Healthcare NHS Trust, has seen many women who feel isolated and excluded.

“A recent pan-European consumer study found nearly eight out of ten people didn’t know that metastatic breast cancer was incurable,” explains Dr Harmer. “The research also showed many women with the disease didn’t fully appreciate the implications of their diagnosis.”

Women with metastatic breast cancer can live well for years, but many struggle with other issues in addition to their physical health.

“When considering treatment, many things need to be taken into account, including the psychological wellbeing of a patient, their socio-economic needs and their wider support network,” confirms Dr Harmer.

The good news is that continual

A routine mammogram followed by a biopsy in 2014 confirmed that Ms Wada had cancer. By late 2015 early 2016, she received confirmation that it had spread to her spine.

Whilst Ms Wada’s schedule is now pretty full with scans, oncologist appointments and check-ups, nothing stops her living life the way she wants to.

“I believe that your body follows your mind, so I’m very optimistic,” she says. “Fortunately, the drugs can be taken as tablets at home and there aren’t many side effects. Of course I do get tired and have to listen to my body, but I’m still working and getting on with life.”

Thanks to the support of her great medical team the cancer has been contained, so Ms Wada’s only frustration comes from those who are unable to see past her condition. “It’s too much for people,” she says. “It’s almost like I have to

When it comes to metastatic breast cancer, few of us fully appreciate the impact of a diagnosis.

Dr Victoria Harmer Macmillan Consultant Nurse at Imperial College Healthcare NHS Trust

assessment and the support of multidisciplinary teams are helping to improve both survival rates and quality of life for patients.

“Support is getting better; standards of care and treatments are improving; and overall, the future is encouraging,” concludes Dr Harmer. A wider public appreciation of the challenges facing these women, would certainly help too.

Novartis Oncology

When Toyomi Wada was diagnosed with cancer, she was determined to continue living life to the full.

Toyomi Wada Financial Translator

comfort them through it, but for most people I’m just the same.”

In addition to the personal support she receives from her medical team, Ms Wada has found great encouragement from others living with cancer who she meets via a local charity. “None of us know what tomorrow will bring,” she says cheerfully. “So each day is a miracle, we must be thankful for.”

Changing

At Novartis, we use sc We are passionate ab

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Novartis Pharmaceuticals UK Limited

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This article is funded by Novartis Pharmaceuticals UK Limited. Editorial control remains with the authors.

The doctor: While there is no cure for metastatic breast cancer, focus remains on controlling the condition and improving quality of life.

“The treatment for primary breast cancer is cure driven,” explains Dr Alistair Ring, Consultant Medical Oncologist at The Royal Marsden Hospital. “When treating metastatic breast cancer, which is when the cancer has spread, we are looking to control the cancer for as long as possible and to maintain quality of life.” Thanks to medical advancements, oncologists are now able to determine the molecular makeup of cancer more accurately, leading to more targeted and personalised treatment. There are also more therapies currently being trialled, including focused radiotherapy, which may be able to eliminate cancer completely in patients who have a small number of cancerous spots, known as oligometastases.

Less toxic treatment PHOTO: THINKSTOCK

While a cure remains elusive, any advances that keep patients out of hospital and at home with their

Dr Alistair Ring Consultant Medical Oncologist at The Royal Marsden Hospital

friends and family are met with great excitement. Just this month, researchers have reported a new, targeted treatment, which may delay the need for chemotherapy for up to one year. “Do these developments equate to a cure? Not yet. Are we getting better at controlling the condition?

Absolutely,” concludes Dr Ring.

g the practice of medicine

cience-based innovation to address some of society’s most challenging health care issues. bout discovering new ways to improve and extend people’s lives.

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INSIGHT

New breast cancer care may mean fewer side-effects

By Victoria Briggs

Radiotherapy treatment can leave breast cancer patients with a range of unwanted side-effects, but new care options are on their way.

Women with breast cancer are soon set to benefit from new radiotherapy treatment options being made available. Following surgery to remove the primary tumour, breast cancer patients are currently administered radiotherapy to reduce the risk of the cancer returning.

“The standard provision for radiotherapy had traditionally been given in daily doses over a five week period, concentrated on the whole breast,” says Dr Duncan Wheatley, consultant clinical oncologist at the Royal Cornwall Hospital in Truro.

Dr Duncan Wheatley Consultant Clinical Oncologist

A previous study had proven that a three week schedule of whole breast radiotherapy was just as effective at reducing the risk of cancer coming back, but had less short- and longterm side effects. An ongoing study,

involving a one-week course instead of the (now usual) three weeks, ‘FAST-Forward’, funded by the National Institute of Health Research (NIHR), has already been shown to have fewer short-term side effects, and long-term results are eagerly awaited.

In a new, separate study, ‘IMPORT LOW’, funded by Cancer Research UK and published in the August issue of The Lancet, radiotherapy given to a partial segment of the breast, in the area where the cancer was removed, was shown to be just as effective as when treatment is given to the whole breast.

“Because you’re treating a smaller area, there are also fewer side effects involved. Partial breast radiotherapy means being able to not only reduce the risk of the cancer recurring, but

also to do less harm to the areas we don’t need to treat, like the healthy breast tissue, and the heart and lungs underneath,” says Wheatley.

The new treatments will become the standard model of care very soon, Wheatley predicts, and will herald better outcomes for patients and health providers alike.

“They don’t require a great change in technique, are easily implementable and don’t cost any extra,” he says.

“The reduced treatment schedule is also likely to prove much more convenient for patients, too.”

We are delighted that the efforts of the funders, patients and researchers has proven so effective and will benefit patients around the world.

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A spotlight on breast cancer Mum of two, Kim, has had breast cancer three times in the last ten years.

Kim

“The first time, I felt like my life was over. I internalised everything” she explains. “The boys were doing exams and I didn’t want my illness to distract them. “ “The second time I gave myself a talking to: “‘You’ve got through it before; you’ll do it again.”

“The third time, I took control. I started with small things, like shaving off my hair for charity rather than waiting for it to fall out, which was really empowering.”

Kim speaks warmly of her friend Ange. “She’s been a tower of strength. She always visit-

ed and treated me like the person I am rather than a sick person. I feel very lucky – everyone needs a friend like Ange”. Ange introduced Kim to Breast Cancer Haven. “They were a lifeline. I had counselling, which helped me to decide what I really wanted from life. It gave me time to focus on myself, which calmed my thoughts and helped me to relax”.

“I see things very differently now. Before my diagnosis I wasn’t making the most out of my life. I am much more positive now”.

“I love jive dancing, I have a renewed love of dress making and I have completed a degree in business leadership. I was very proud to graduate with my headscarf under my mortarboard.

“I wouldn’t say that I’m back to my old self because the old Kim no longer exists. I’m a better version of her and I credit my family, friends and Breast Cancer Haven for helping me to find the new me”.

The lives of approximately 1,000 people a month in the UK are cut short by secondary breast cancer.

Against Breast Cancer are dedicated to reducing this number by funding research into prevention, diagnosis and treatments for this devastating disease, with a special interest in glycobiology.

Today we are supporting research in 4 key areas: • developing tools for the earlier diagnosis of secondary breast cancer • developing new treatments targeted at secondary breast cancers • understanding which diet and lifestyle factors impact risk of recurrence or spread • providing a platform for communication between scientists and industry to drive the scientific field forward

To learn more about our research strategy and funding process, visit: againstbreastcancer.org.uk/researchers/ Or email us at: info@againstbreastcancer.org.uk Against Breast Cancer is a registered charity in England and Wales.

Registered Charity No. 1121258

In the UK today, around 150 women will receive a breast cancer diagnosis. By 2035, this is projected to rise to over 200.

M

ark met Tina on a blind date arranged by his brother who knew of their mutual love of motorbikes.

The couple married and while pregnant with their first child, Tina discovered a lump in her breast. However, she was reassured that lumps were commonplace during pregnancy.

Three days after giving birth, Tina was diagnosed with breast cancer and underwent a mastectomy.

Tina’s treatment led to her experiencing early menopause, so it came with great surprise and joy when Tina discovered that she was pregnant again.

Six months after the birth of their second daughter, Tina’s annual checkup revealed that her cancer had returned and had spread to her liver and bones.

Her treatment was successful in reducing the size of the tumours but the side effects caused her great discomfort.

Mark

Mark remembers, it was on a Sunday morning when Tina had woken with a terrible headache.

An ambulance rushed her to hospital where scans revealed a cerebral bleed requiring emergency surgery. Despite all efforts Tina passed away overnight.

At just 47 years old, this marked the tragic and abrupt end to Tina’s 16 year fight against breast cancer.

Read more on healthawareness. co.uk

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CANCER PREVENTION TOP TIPS

The modern alchemy of breast reconstruction

By Linda Whitney

Lipofilling

Breast cancer patients now have high expectations of reconstruction, so surgeons need expertise in both reconstructive and cosmetic techniques.

Read more on healthawareness.co.uk

Breast reconstruction is now integral to breast cancer care and an outdated, ‘one technique for all’ approach no longer suffices.

So says Paul Harris, Consultant Plastic Surgeon at The Royal Marsden NHS Trust and Vice President of the British Association of Aesthetic Plastic Surgeons (BAAPS).

“Patients want a result that looks and feels natural, not just something to fill the bra,” he says, “so surgeons must be fully trained in all aspects of reconstructive and aesthetic breast surgery.”

Multiple techniques are now used to create a bespoke solution for each patient. “The older patient who has had radiotherapy and chemotherapy and a flat chest wall for a few years needs a different combination of techniques to the younger woman having a double mastectomy because she has a genetic predisposition to breast cancer,” says Harris.

Paul Harris Consultant Plastic Surgeon at The Royal Marsden NHS Trust and Vice President of the British Association of Aesthetic Plastic Surgeons (BAAPS)

Dermal matrices Reconstructions are no longer limited to implants, but can also use dermal matrices - sheets of deeper layers of animal skin, processed to remove the skin cells, leaving only the collagen.

“Matrices have made implant surgery a onestage procedure,” says Harris. “In the past, implants could not fill out the whole breast, so a tissue expander was used before the more permanent implant was inserted during a second operation. Now, the muscle of the chest wall is used to cover the upper part of the implant, while the matrix covers the lower part, so one operation gives a full breast.”

Minor adjustments can be made using another new technique: lipofilling. This involves removing fat tissue from the patient’s thighs, belly, or buttocks by liposuction and injecting it into the breast area.

“This mix of implants, dermal matrices and lipofilling is becoming standard in the NHS and the NHS is supporting surgeons to learn techniques from the cosmetic sector to achieve better outcomes,” Harris says.

Patients may also have subsequent surgery to adjust the remaining natural breast to achieve symmetry – another mix of cosmetic and medical procedures, available in the NHS.

What of the future?

Harris says: “Soon we expect the introduction of lighter implants and greater understanding of why they sometimes fail. Longer term, gene therapy may be used to protect the reconstructed breast from the damaging effects of radiotherapy.”

Read more on healthawareness. co.uk

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INSPIRATION

World Cancer Research Fund

A healthy diet can help with cancer’s side-effects Cancer treatment can cause several side effects, including weight loss, weight gain and digestive issues.

Supporting your body with a healthy diet is especially important for cancer patients undergoing treatment, yet many receive no nutritional advice.

N

early half of all cancer patients going through treatment receive no dietary advice to help them manage their debilitating side-effects, a survey by the World Cancer Research Fund charity has found, while a further 21 per cent only get ‘a small amount’ of advice.

Eat Well During Cancer is a free booklet produced by the charity that helps those with the disease to cope better through healthy eating.

Endorsed by the British Dietetic Association, the booklet advises on the types of food that can help off-set the side-effects of cancer treatment, like constipation, diarrhoea and fatigue.

Weight loss is a particularly common side-effect of treatment, when patients are unable to eat as normal or absorb nutrients.

In some cases, this can lead to malnutrition and reduce tolerance to treatment. Other treatments, such as hormone therapy and steroids, may cause weight gain.

Recipes that include foods like salmon, avocado, seeds and nuts are all high in healthy fats – essential for those experiencing weight loss.

Order your free copy of Eat Well During Cancer from World Cancer Research Fund healthawareness.co.uk

PHOTO: THINKSTOCK

Supporting women at all ages Frances Quinn, Great British Bake Off winner, partners with the Breast Cancer Haven to support those affected by breast cancer.

“60,000 people a year in the UK are diagnosed with breast cancer; that is a lot of people. It brings it home just how many of us will be touched by the disease at some point in our lives.

It works out at one in eight women in the UK alone and most of us know someone who has been affected.

What is maybe less well understood is how varied the responses to hearing that news, ‘you have breast cancer’, can be. Everyone reacts and deals with the news differently, of course. A 20 year old might be worried about how the diagnosis would affect their chances of having a family in the future, a 40 year old may be worried about telling their partner and a 70 year old may worry about how they will cope with the difficult side effects of treatment.

From the moment I started working with the charity’s London centre, I

Frances Quinn Designer and Baker

realised just how well they understood all these concerns.

They are a National charity that supports women through their breast cancer treatment.

When breast cancer tries to rob a woman of her individuality, her confidence or her strength, they provide a tailored package of emotional, physical and practical support that helps her hold on to them.”

The charity supports women and their families via a network of six welcoming centres around the UK and through an expanding network of other services. They provide women with breast cancer the support that treatment alone can’t. Working alongside each individual, a

qualified healthcare specialist will build a programme of support that addresses their personal fears, symptoms and concerns, helping them to live the best life possible, during and beyond their breast cancer diagnosis. This might include counselling, massage or nutritional therapy among others.

“Breast Cancer Haven’s nutritional therapy programme really inspired me.

Cancer treatments notoriously result in unbearable nausea and digestive issues. Providing people with specialist advice on how to manage this free of charge, just through the way we eat can be literally life changing. The NHS does an incredible job at treating cancer and I am so thankful that somewhere like Breast Cancer Haven exists to help people support others beyond their medical treatment and through their toughest times.”

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Breast cancer tech boosts chemo care decisions

By Ailsa Colquhoun

SPONSORED

Improved understanding of cancer and the gene defects that cause the disease have been captured in a test that can fine-tune the way cancer patients are treated

For many years, researchers and clinicians thought that all cancers from the same site were essentially the same.

But now they understand that each cancer is an individual disease, and that if they are to treat it successfully, they need to find treatment solutions that are equally as personal.

For the majority of cancer patients, surgery remains the cornerstone of treatment, together with chemotherapy and radiation therapy. The problem, however, is that for some breast cancer patients, chemotherapy offers little extra benefit - and at the same time may expose the patients who receive it to a raft of unpleasant and often debilitating side effects.

Cancer occurs because of faults in the human genes that control cell growth. These damaged growth genes are called ‘oncogenes’ and damage can occur for three reasons: ■■ The person is born with a defective gene, such as the BRCA breast cancer gene.

■■ The person is exposed to toxins in the environment, such as cigarette smoke, which can damage

Dr Caroline Archer Consultant Oncologist, Portsmouth Hospitals NHS Trust.

the genes.

■■ Genes can simply wear out, which

partially accounts for the increase in cancer incidence as we age.

Anticipating how people with cancer will benefit from their treatments has perplexed cancer specialists for a long time. Research has made clear that even though two cancer patients may have the same cancer type, each patient within that type will have a unique tumour based on individual factors including their genetic profile.

“This is entirely new knowledge, so what we are trying to do now in the medical community is to identify for each patient his/her type of disease and then to give the drug that will work best,” says Dr Caroline Archer, consultant oncologist at Portsmouth Hospitals NHS Trust.

The thinking is that when treatment gets personal everyone will benefit: ■■ patients will receive access to a range of new more effective, targeted treatments.

■■ scientists will be able to develop

new drug treatments that target specific genetic faults and design more efficient clinical trials.

■■ doctors will be given access to high-quality genetic tests that enable them to tailor treatment for each patient.

■■ the nhs will benefit from time and cost savings so doctors can treat patients more effectively.

How does it work?

score, the higher the risk of recurrence and the more likely it is that chemotherapy will have an additional benefit.

Importantly for a health system that needs to ensure every penny of taxpayers’ money is well-spent, the UK’s medicines watchdog, the National Institute for Health and Care Excellence, has endorsed use of the test in the NHS as a cost effective part of breast cancer care. To date, Oncotype DX is the only test of this type to receive this endorsement and it is the view of Dr Archer that it has saved thousands of patients the burden of chemotherapy, that might cause them to lose their hair, suffer sickness and extreme fatigue and loss of earnings if they are unable to work. For the health service, the benefit is tens of thousands of pounds saved on an expensive therapy offering little significant incremental benefit. Her hope is that in the future this test may also be recommended for use in other types of breast cancer, and for similar technology to be developed for other cancers, for example, prostate cancer in men.

She says: “Certainly, chemotherapy has financial implications for the health service, but it also has significant personal implications for the patient. By using this test, we hope to identify those patients who will be able to do as well without chemotherapy as they will with it.”

The test analyses a group of 21 genes found in a sample of breast cancer tissue taken during surgery. The results are presented as a Recurrence Score, which will be a number between 0 and 100. The higher the

Read more on healthawareness.co.uk

What is Oncotype DX? Oncotype DX is a test that the NHS is now using to help doctors decide how to treat a person’s breast cancer, and in particular, whether chemotherapy will be of benefit. Whether you are offered chemotherapy depends on a number of factors.

These include: ■■ the type of breast cancer you have ■■ the grade of the breast cancer ■■ the size of the breast cancer ■■ whether there are signs the cancer has spread By measuring gene activity, Oncotype DX scores a person’s risk of cancer recurring, which allows doctors and patients to discuss with more confidence how likely your cancer is to respond to treatment with chemotherapy. Dr Archer says: “Things are not always clear cut in medicine and this gives the clinician and patient extra confidence in the treatments being recommended.”