A new research programme being launched in Dundee this month Breast Cancer Awareness Month aims to reduce the incidence and extent of surgery for some breast cancer patients. Helen Brown spoke to study leader Professor Alastair Thompson about what this groundbreaking research will mean for patients.
This year, 1.4 million women across the world will be diagnosed with breast cancer. In Scotland alone, 1,000 wives, partners, mothers, daughters, sisters and friends are lost to the disease every year. Over the last 10 years (2002-2011) over 3,000 women in the NHS Tayside area were diagnosed with breast cancer and 906 women have died.
But and it’s an important but a diagnosis of breast cancer is no longer the inevitable death sentence it once might have been, thanks to research, improved methods of detection and better standards of treatment and care.
Breakthrough Breast Cancer is now funding its first new research programme in half a dozen years in Dundee and is looking to raise £850,000 over the next five years to support it.
The aim? More effective treatment for breast cancer patients, reducing the extent and impact of surgery. And how? By working together with different disciplines in which Dundee excels breast and skin cancer teams regarded as among the best in Scotland and in Europe, with the addition of the skills offered in medical imaging, cell biology and behaviour, mathematical modelling and physics.
Breakthrough researchers predict that almost 3,000 women a year across the UK might avoid large-scale surgery, enjoy improved quality of life and better survival rates.
Leading this vital clinical trial is Professor Alastair Thompson, professor of surgical oncology at Dundee University. He is the university’s director of breast cancer research and he and his team are based at Ninewells, perfectly placed to translate research findings and developments into practical benefits for real patients.
“It’s teamwork in a place where life sciences are regarded as a having reached a pinnacle of achievement – the NHS breast service here admired internationally. It’s one of the reasons that Breakthrough were keen to work with us. It’s not too much to say that this project could only be done in half a dozen places globally.”
Fundamentally, breast cancer is more and more common and there are recognised and long-standing ways to treat it lumpectomy or radical mastectomy, radiation to kill cells or drug therapies to poison them.
But according to Professor Thompson, diversity is a key to be used against cancer and its Achilles heels.
“We’ve been moving, with the UK at the forefront over the past 25 years, to a more thoughtful approach rather than surgery as a first resort.
“When a woman presents with breast cancer, there is the option of leaving the cancer in place, using the drugs we have and watching the effects.
“At the moment, there can be very great discrepancies in what happens in such cases from no response at all to complete dissolution.
“In about one third of cases, chemo upfront before surgery should achieve very good shrinkage of a tumour.
“That can significantly reduce the scale of surgery which can have a very positive effect on post-surgery quality of life, as the look, feel and sensation of the breast can be retained.
“But this type of pre-surgical treatment, called neo-adjuvant chemotherapy (NAC) is not always effective and what it might do is currently impossible to predict.
“What we want to do is develop ways to identify patients in whom this technique will be a success, assessing each patient’s tumour and taking the element of chance out of the decisions we have to make.”
Imaging is central to this study.
“To take an example of a woman who has just had breast cancer diagnosed; say the cancer is two centimetres or more in size. Would it be best treated by surgery or pre-surgical methods?
“Some of these things we do anyway but this will allow us to bring in things we haven’t tried, to focus and crystallise much more closely.
“For a long time, we’ve been realising that it’s not just cancer cells that matter, it’s the host, the tissue surrounding the cancer, the collagen, the muscles, the blood vessels that are just as important.
“On balance, we have been historically good at killing cancers but not that good at recognising how women react to the ways we do that.
“Think of it as a plant in soil, growing and nurtured by that soil, the environment it’s growing in.
“We can use imaging to look not only at the cancer and its progress but at the site of the tumour what’s going on the ‘soil’ around the seed and plant of cancer.
“You can’t forget you are treating the whole person, the mindset as well as the site of problem. If what we do becomes more patient centred, that’s definitely a ‘virtuous circle’.
“This project will certainly encourage a much more individualised approach to each case, changing women’s perception about going for surgery a gut instinct to do that is perfectly understandable, ‘chop it and do it tomorrow’.
“That isn’t necessarily wrong but taking a different view can give a better outlook, 10, 20, 30 years down the line, letting us learn more about particular women’s cancers, bodies and responses.”
Another critical element strongly represented in Dundee is the history here and in Scotland in general not only of generous fund-raising but of people willing to support research personally.
“That can be in ways that can be more or less inconvenient to themselves from providing extra blood samples to donating tissue for research. Tayside and Fife patients make an amazing contribution and it’s a huge strength.”
Where breast cancer patients are concerned, few are unwilling: “Only about one in 50, I would say. Many individual women have nothing to gain but there’s a selflessness in their outlook and a confidence in what we do here which is why these figures are so high.
“Without public/patient support, we couldn’t be the No 1 centre for trials in the UK and internationally recognised.”
A cure for cancer of whichever kind still seems like pie in the sky. But time and the odds are much more on our side than they used to be.
Professor Thompson added: “With breast cancer, 30 years ago, six out of 10 people were alive after five years; now, that has risen to nine out of 10 after five years with most surviving 10 years and often beyond. It’s gone from not far off flipping a coin to really good figures, from killing too many women to looking at many who have a true quality of life or are completely cured.”
For more information visit www.breakthrough.org.uk