Campaigners want 10 gaps in breast cancer research to be tackled

http://www.theguardian.com/society/2013/oct/01/breast-cancer-research-gaps

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Ten critical gaps in breast cancer research must be tackled if the current death toll is to be checked, according to the Breast Cancer Campaign.

It says that if action is not taken to tackle these gaps by 2030, 185,000 more people will die of the disease. About 50,000 women and 400 men are diagnosed each year and about 12,000 lives are lost.

The gaps range from identifying lifestyle changes which could enable women to protect themselves from the disease to a better understanding of how tumours grow and spread to other parts of the body.

The campaign has involved more than 100 scientists, doctors and other healthcare professionals in compiling its list. The research behind it is published in the international journal Breast Cancer Research.

Some of the gaps concern the need for new treatments – particularly for secondary or metastatic cancer, where the tumour spreads to other parts of the body. There is a real need for biopsies, or tissue samples, to be taken from these secondary cancers, because they are often not the same as the primary cancer, say scientists.

Clinicians, said Prof Alastair Thompson from the University of Dundee, who is a cancer surgeon and one of the authors of the report, may be reluctant to put patients through a biopsy when they have metastatic disease but he believed patients would agree to it once they understood the amount of valuable information this could yield.

"A very, very small proportion of women have biopsies of metastases. It could transform the way we care for our patients in the NHS and the UK and I suspect we would be a step ahead of much if not all the world."

Prof Sue Eccles, from the Institute of Cancer Research in London, a co-author of the report, said: "We are basing our treatment on what the primary cancer looks like.We need to know what's going on in that secondary cancer. It is a different beast from the primary surgical specimen that most of us have to look at."

The authors also want breast screening targeted at those who will benefit most, instead of urging everyone to have a mammogram, by finding ways to assess an individual woman's risk of cancer. More work is needed to understand what it is that enables breast tumours to become resistant to drugs and to spread throughout the body.

Another significant gap is in prevention. A better understanding is needed of which sustainable changes in lifestyle, such as diet and exercise, can reduce a woman's chances of developing cancer in the first place.

With changes to lifestyle, said Thompson, "we could reduce the number of women who develop cancer significantly. The analogy is with cigarettes and lung cancer – or better still, heart disease."

Research funded by the Breast Cancer Campaign has already shown that women who eat a high calorie diet in their mid-30s to mid-40s can end up with dense breast tissue in their 50s, which puts them at higher risk of breast cancer. The campaign estimates that if individual risk can be better identified by 2025, up to 20% of all breast cancers could be prevented.

The campaign says that an increase in funding for breast cancer research is needed if the gaps are to be filled.Lady Morgan, the campaign's chief executive, said resources for fighting breast cancer were starting to tail off. "I think that is unacceptable in the most common cancer, where we have 1.2 million women living with the consequences," she said.

She added that the gaps now identified were enormous and difficult to tackle, but said it could be done. "I really think we can see a future where breast cancer can be overcome," she said. "I think it is a very positive and optimistic message for women."

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