Breast Health - Q4 - Dec 2018

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Breast Health “We urgently need to support more women to actively reduce their risk of breast cancer” Baroness Delyth Morgan Chief Executive, Breast Cancer Now

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New imaging technique could reduce the number of repeat breast cancer operations

How radiographers are key in the diagnosis of breast cancer

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ONLINE “Many breast cancers are still found by women themselves through self-checking” CoppaFeel!

Act now to take control of your breast health With around 55,000 women still hearing the words ‘it’s breast cancer’ each year in the UK, we urgently need to support more women to actively reduce their risk.

More women are now being diagnosed with breast cancer than ever before. One in eight will face the disease in their lifetime, and – despite major research progress – around 11,500 mothers, sisters and daughters are still losing their lives every year in the UK.

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e need to act now, and preventing the disease in the first place is one of the most powerful weapons we have.

That’s why it’s so important that Follow us

more women are supported to take steps to reduce their risk.

While we cannot change some things that affect our risk, such as getting older, there are others we can do something about. By making small lifestyle changes now, including exercising regularly and drinking less alcohol, all women and men can reduce their chances of developing breast cancer in the future.

Eating a balanced and varied diet – rich in fruit and vegetables and low in red and processed meat, and fatty and sugary foods – can also help you MediaplanetMarketing

lower your risk by keeping you at a healthy weight.

There are also lots of ways to reduce your breast cancer risk by being physically active on a daily basis – whether by walking to work, gardening or taking the family for a bike ride. Any activity that makes you warmer, breathe harder and makes your heart beat faster will help.

But with incidence rising, we also need to detect more cases earlier – where treatment is more likely to be successful. Although more common in older women, breast cancer can @MediaplanetUK

Baroness Delyth Morgan Chief Executive, Breast Cancer Now

also occur in younger women – which is why we’re urging women of all ages to Touch Look Check.

Just get to know what your breasts look and feel like normally. It doesn’t matter when, where or how you check, as long as you do it regularly.

This makes it easier to spot any unusual changes – like a lump, an inverted nipple, or discolouration.

If something doesn’t feel right, it’s important to see your GP straight away. While most cases will turn out to be harmless two thirds of breast cancers are found by women noticing unusual changes and @MediaplanetUK

getting them checked out.

Our aim is that, by 2050, everyone who develops breast cancer will live – and live well. But with the disease still taking lives on a heart-breaking scale, we must do everything we can to prevent more cases, improve early detection and find more effective treatments. It’s time to act.

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07960 715952 tasmiabreastcare.co.uk UK Clinic: 16A Well Hall Parade, London, SE9 6SP

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My body had literally nitto left to give and radiotherapy well and truly put the boot in. Exhausted, emotionally raw with what feels like every sodding emotion sat at the surface, I haven’t been in the right headspace to dissect and share something as heart-wrenching as my chemo experience. Until now.

Lauren Mahon, 32. breast cancer survivor and creator of Girl VS Cancer

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New technology may reduce breast cancer operations More patients could be spared the agony of repeat breast cancer operations by a new imaging technique that could be available soon. Here's how.

Up to a fifth of those who have a breast cancer lump removed in the UK need a second operation to remove residual cancer that was missed the first time round.

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ow, a new imaging technique, which could be available within a few years, aims to reduce the number of repeat operations.

“However careful the surgeon, in a minority of lumpectomy operations some of the tumour is left behind, so a second operation is required.

This is a global problem and in the UK happens 10-20% of the time,” says Professor Arnie Purushotham, Cancer Research UK Senior Clinical Advisor and Consultant Surgeon, Guy's and St Thomas' NHS Foundation Trust.

“Repeating the surgery means

more pain and distress for the patient and their family and could increase complication rates.

Sometimes this can also mean that the second operation required may be a mastectomy.”

Ensuring complete tumour removal is no easy task Tumours are rarely spherical.

Usually they are eccentricallyshaped and have ‘tentacles’ that reach into the surrounding tissue.

Without a clear idea of the shape of the tumour and size and reach of the tentacles, ensuring complete removal can be hard.

“Surgeons use information from mammograms, ultrasounds and sometimes MRI scans to get as accurate as possible threedimensional assessment of the size and shape of the tumour before the operation. In theatre they remove

the tumour and a surrounding ‘fringe’ of normal tissue, and X-ray it to check that the fringe completely surrounds the tumour,” says Purushotham. “This can sometimes be hard to see on a two-dimensional, black and white X-ray.”

A new solution Now, an emerging molecular imaging technology called Cerenkov Luminescence Imaging (CLI) could help make the edges of tumours clearer. Cerenkov luminescence is a light emitted from a radioactive isotope as it starts to decay, and Purushotham has been involved in the development of a new technique that can detect it.

The imaging machinery is designed to be used during the lumpectomy operation. Patients are injected with a radioactive tracer, the light from which can be

Professor Arnie Purushotham ham eon, Senior Clinical Advisor and consultant surgeon, Cancer Research UK, Guy’s and St Thomas’ NHS Foundation Trust

detected by the imaging machine, thus highlighting the tumour more clearly.

"If you cannot see a full fringe of normal tissue completely surrounding the tumour, or the light from the tracer passes through the fringe, it is likely that some of the tumour has been left behind and the surgeon can rectify that on the spot," Purushotham says. “This should mean that surgeons are more likely to catch the full extent of the tumour the first time and reduce the rate of re-excisions” An initial study, carried out in 2016-17, used the technology to examine tumours already removed from 22 patients. “The tumours showed up as a different colour against the background of normal tissue, making it easier to see the extent of the tumour,” says Purushotham.

Next first-in-human trials in patients in 2019 The next first-in-human trials of the technology are scheduled for 2019, based in Guy's Hospital, London.

“It should not take long for trials to show whether CLI is an improvement on existing methods, so if it proves to be helpful in reducing the need for second operations, it could be in clinical use within the next few years,” Purushotham says.

Moreover, if CLI is proven to be valuable in breast cancer lumpectomies, it could also prove useful in surgery for other solid cancers, for example in prostate, stomach, colo-rectal and lung cancer.

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New approaches to fighting breast cancer For 25 years, Against Breast Cancer have been breaking new ground funding research into the main cause of breast cancer related deaths, secondary breast cancer. Our goal is to improve detection, treatment and to increase survival after diagnosis.

We are investing in new research and working with some of the UK’s most respected academic establishments. This research will focus on how the body’s natural defences could be harnessed to design more effective treatments. These treatments aim to recognise and destroy secondary cancer cells, while avoiding any damage to the healthy surrounding tissue, and therefore minimising the patient’s side effects.

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SUZANNE DANDO REYNOLDS BEM, PATRON

dedicated time for talks and open days to help the charity educate and raise awareness among its supporters.

As a patron, I started supporting ABC back in the early 1990s; I could never have imagined I would still have such a wonderful association with this amazing charity.

When Dr Anthony and his wife, Pat started out 25 years ago, it was their skill, determination and sheer hard work that inspired me.

What makes this small charity so unique is our history of funding long term-projects which is why we have committed £2 million to funding research at Southampton for the next 10 years.

We desperately need new treatments that target all types of secondary breast cancer cells before they have the chance to grow into tumours, wherever they may be in the body.

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Focus on new treatments At the University of Southampton, Professor of Glycobiology, Max Crispin and his team, are exploring innovative techniques to develop anti-cancer antibodies that can detect and destroy breast cancer cells, including secondary breast cancer, without damaging surrounding healthy tissue.

Having worked together for the past four years, our partnership is perhaps quite unlike any other and works so well because we have such well aligned goals.

In 1987, Against Breast Cancer’s co-founder, Dr Anthony Leathem discovered secondary breast cancers had an unusual arrangement of sugars on the cancer cell surface. It is this special interest in the sugar

biology (glycobiology) that sets our research apart.

Professor Crispin runs the Glycoprotein Therapeutics Laboratory, which is developing new therapeutic approaches for the treatment of cancer, based on refocusing of the immune system to destroy cancerous cells.

Secondary cancer cells are decorated with abnormal sugars, which are implicated in their ability to move around the body and establish secondary tumours.

These sugars are potential targets for the antibody component of the body’s immune system. People who develop secondary cancer may benefit from antibodies that have been made that stick to these targets on cancer cells and render these secondary cancerous cells detectable by the immune system - wherever they are in the body.

He explains the extent of the collaborative nature of this cuttingedge research: “Against Breast Cancer is a remarkable charity. They realise the need for long-term support for challenging research programmes and our relationship has been cemented further by the charity’s continuing commitment to fund breast cancer research here at Southampton and well into the future. We are fortunate that the research team also includes Professor Steven Beers and Dr Charlie Birts within the Centre for Cancer Immunology who have the expertise to determine the effectiveness of the new drug candidates in pre-clinical models.”

And it really is a partnership.

Each member of the research team at Southampton has involved themselves in fundraising and

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e envisage a future where a blood or urine home test kit could enable earlier diagnosis and easier monitoring of the tumour response during treatment. Our aim is to provide the patient with peace of mind through routine home checks, removing the need for multiple visits to hospital.

Diet and lifestyle choices may increase or reduce the risk of secondary breast cancer developing.

To provide sound, evidencebased advice relevant to the UK’s population, we are working to improve our understanding of the biological differences between patients who develop secondary spread and those who do not, to reduce the risk of reoccurrence.

Max Crispin Professor of Glycobiology,

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New breast cancer treatment could prevent side-effects of traditional surgery Radiographers have key roles in NHS screening programmes

All women in the UK aged 47-70 are offered a three-yearly breast cancer screening within the NHS breast screening programme. There is ms, ongoing debate about the balance of its benefits and harms, both in the UK and internationally.

Stuart McIntosh Clinical Senior Lecturer, Surgical Oncology/Honorary Consultant Breast Surgeon,

Sue Webb President, Society and College of Radiographers

Screening programmes identify medical conditions and diseases as early as possible, often before people have symptoms or know there may be something wrong.

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wo of the most widely used screening programmes - breast and abdominal aortic aneurysm screening - save lives by providing evidence to health and medical professionals that something is wrong, how serious it is, and to help make decisions about the best next course of action.

Mammographers, or breast specialist radiographers, carry out two million examinations a year as part of the NHS Breast Screening Programme, primarily on women aged 50 to 70 years. Many of the mammograms are checked by reporting radiographers, who will find signs of cancer in eight out of a thousand women who have been screened.

It is estimated that the abdominal aortic aneurysm (AAA) screening programme has cut early deaths by half among men aged 65 years and above. It is assistant practitioner radiographers who carry out the scans that measure the abdominal aorta, a major artery. The procedure gives early warning of a possible aneurysm, which could rupture and cause life-threatening bleeding.

Monitoring the nation’s health Nine out of ten people who go to hospital as an in- or out-patient will see a diagnostic radiographer, who will produce high quality and accurate images to diagnose injury, abnormalities or disease. Before treatment can take place, a medical practitioner needs to have the best possible idea of what is happening inside the patient’s body to understand what it is that may be wrong.

The radiographer has an increasing range of diagnostic imaging options available including x-rays, CT, MRI, and nuclear medicine, as well as ultrasound. They are also increasingly reporting on clinical images.

First in the fight against cancer Therapeutic radiographers deliver radiotherapy services to four out of ten people who have been diagnosed with cancer. They plan and deliver highly accurate doses of radiation to the site of the tumour, while minimising the amount of exposure to surrounding healthy tissue. They also have a key role in caring and supporting patients during their treatment.

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Centre for Cancer Research & Cell Biology, Queen’s University Belfast

For every breast cancer death prevented, there are estimated to be three overdiagnoses; that is, the detection of cancers that would not have become apparent during that person’s lifetime had they not had a mammogram. Such women are subsequently treated and exposed to the potential side-effects and harms of treatment as a consequence.

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new, randomised, controlled trial, due to open to recruitment in early 2019, aims to tackle this issue.

Mr Stuart McIntosh said: “There has been ongoing and sometimes heated debate about the balance of benefits and harms from breast cancer screening. It reduces deaths from breast cancer, but overdiagnosis is a problem. So, looking for ways to de-escalate treatment and reduce harm is important.”

Five-year study tests lessinvasive breast cancer treatment The SMALL study, as it’s named, will look to compare standard surgery (usually a lumpectomy and a lymph node biopsy, under a general anaesthetic) with a minimally invasive technique called vacuumassisted excision in women with screen-detected early breast cancer.

This ‘de-escalation’ of treatment has the potential to change the way screen-detected breast cancer is treated by the NHS. The SMALL study, funded by

the National Institute of Health Research (NIHR), will test the vacuum-assisted excision technique. It will only require an outpatient appointment and a local anaesthetic, so is a much smaller, non-surgical intervention. Although this technique is in widespread use in the breast screening programme for treating benign breast lumps, it has not – until now – been used to treat breast cancers.

The results could save the NHS £2 million The study will recruit 800 women over four years with early stage breast cancer detected through the NHS screening programme, with 500 of those women assigned to the test treatment. All patients will then be followed up for five years.

If the less-invasive test treatment is found to be as effective as current standard treatment for early stage breast cancer, then this study will potentially change clinical practice.

Mr Stuart McIntosh, lead investigator for the SMALL study says: “Not only does this study have the potential to spare some women unnecessary surgical treatment, it could also bring cost-savings for the NHS.” It is estimated that, for the 500 women due to receive the test treatment, over £2 million could be saved.

Collaboration with researchers and clinicians is key Such potentially practice-changing studies do not come into being on their own. The development of the SMALL study involved collaboration

from researchers and clinicians from a wide range of specialities. Through the National Cancer Research Institute (NCRI) Breast Cancer Clinical Studies Group, experts from a variety of specialities were brought together to collaborate on the study throughout its development phase.

Harnessing such a variety of expert perspectives makes for a welldesigned study, which is more likely to answer key questions and bring maximum benefits for both patients and the NHS. Patient involvement in breast cancer research In such studies, the patient perspective is hugely important.

Through the NCRI, patient input was integral to the development of the SMALL study from the beginning, and ensured that the aims of the study remained focussed on delivering maximum patient benefit and making certain that the study was acceptable to women with a newly-diagnosed breast cancer.

“There has been patient input into the study from the start and this will continue through the lifetime of the study. As ‘experts by experience’, it adds that crucial perspective in to the mix.”

About SMALL The SMALL study is funded by the NIHR Health Technology Assessment Funding Board.

The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.

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Doctor perspective: taking a tailored approach to breast cancer treatment

Dr Andreas Makris Consultant Clinical Oncologist, Mount Vernon Cancer Centre

A new test helps clinicians understand if a person’s breast cancer will respond to chemotherapy. It’s a major breakthrough, says Dr Andreas Makris, Consultant Clinical Oncologist, Mount Vernon Cancer Centre.

How has treatment for breast cancer changed in the last 10 years?

Survival rates for women with early stage breast cancer have continued to improve every year since the early 1990s. That's partly because women are presenting earlier for treatments such as chemotherapy. Over the last 15 years or so, chemotherapy has been given to most women with early stage breast cancer. But now a new genomic test called Prosigna helps clinicians understand which early stage patients might benefit from chemotherapy — and which might not.

Why is that important?

If a patient is not going to benefit from chemotherapy, there's no reason for them to have it. Chemotherapy can last for months and have significant side-effects which can seriously interfere with a person's life. For example, they may not able to work, and they may find it difficult to look after their children or other dependents. Plus, it delays treatment which could be beneficial, such as surgery,

radiotherapy or hormonal treatment. So there is a cost to the patient — and also, financially, to the National Health Service where resources are limited.

How does the diagnostic test work?

Genes from the cancer are tested after it has been removed in surgery. This indicates its aggressiveness and also its sensitivity to chemotherapy. A high score denotes that chemotherapy would likely be effective; a low score denotes that it would likely not be effective.

How revolutionary is the test?

It's an important way to deliver 'personalised medicine' — which means targeting treatment for individual patients. Also, the difference between Prosigna and other similar diagnostic tests is that it can be performed within the NHS, so samples do not need to be sent overseas. I would say this kind of test has to be one of the most important breakthroughs in the treatment of early stage breast cancer in the last 10 years.

NICE now recommends Prosigna for chemotherapy decisions in early breast cancer. The health policy group selected Prosigna, not only based on its accuracy, but also because of the potential savings for the NHS. Clinicians who are uncertain how best to prevent breast cancer recurrence and also need to manage adverse effects of cancer therapy can now turn to Prosigna to provide reliable answers based on the biology of a patient’s tumour.

How has Prosigna been tested?

In a large trial called OPTIMA, for which I am Co-Chief Investigator, that has been running in the UK and Norway. So far, 1,200 out of 4,500 women have taken part in the trial.

Is the diagnostic test currently available to NHS clinicians?

We are expecting NICE to approve it for use within the NHS for those women with early stage breast cancer — ie, those whose cancer has not spread to their lymph glands. Cancer which has spread to the lymph glands is more aggressive; so those women could receive chemotherapy as well as hormonal treatment and radiotherapy. In their cases, we have to ask: 'Can we use Prosigna to make a decision on whether they receive chemotherapy or not?'

DR DENISE YARDLEY (SARAH CANNON INSTITUTE), DR PASCALE MOREL (NANOSTRING), AND DR ANDREAS MAKRIS PRESENT EVIDENCE FOR PROSIGNA AT THIS MONTH’S SAN ANTONIO BREAST CANCER SYMPOSIUM

Patient perspective: personalised treatment is the future of breast cancer care Tracey Baderr nt Patient

Can you tell me about your experience with breast cancer?

I was diagnosed with advanced breast cancer in June 2015. The lump was 27mm when it was discovered. I considered myself to be in the prime of my life. Work was going well, my husband was finding success as an artist and my three boys (then aged 21, 18 and 15) were my pride and joy.

I had a mastectomy and reconstruction, followed by chemotherapy over sixteen weeks. Since then, I’ve been taking daily hormone therapy and low dose aspirin.

Nothing prepares you for discovering

you have breast cancer, or the awful ramifications – telling your family, undergoing major surgery, filling your body with poison – it makes losing your hair seem like a walk in the park.

How has it affected your quality of life?

Taking daily medication reminds you every morning that this day is different from the first 54 years of your life. You could be enjoying a family event, giving a presentation, or telling a joke, when the thought bubbles up in your head: “What if the cancer has come back?”

It’s difficult pretending that you’re living an ordinary life, when in the back of your mind you know that cancer could be growing inside your body.

Why is personalised treatment so important for the future of breast cancer treatment?

It has been three years since I first held my breath as the doctor confirmed my very worst fears. So far, I have had no obvious recurrence. I have to take drugs every day now to suppress the hormone that feeds the cancer.

The treatment gives me hot flushes, but

if it keeps the cancer at bay, it’s a small price to pay. It’s likely I’ll have to take prescription treatment for ten years – but even that is good news if it means I am still here!

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