Data from Allen Wellings - Curated by EPG Health - Last updated 27 June 2018

At the recent European Breast Cancer Conference (EBCC), held from 21‒23 March, the best and brightest in breast cancer research and care met to present and discuss the latest breakthroughs. Brief summaries of some of the key abstracts are found below.

Risk of breast cancer recurrence can be better quantified in women carrying a BRCA mutation

Research presented by Dr Alexandra van den Broek suggests that the risk of developing breast cancer for a second time can be calculated by testing for several minor genetic variants of the BRCA gene, many of which are known to have a small effect on breast cancer risk.

The researchers studied over 10,000 breast cancer patients who had mutations in the BRCA1 and BRCA2 genes. They then examined the low-risk variants that were carried by each patient, combining their effect on cancer risk, producing a polygenic risk score for each patient. This is a method for summarising the genetic effects of different markers that would not achieve significance if measured singularly.

The results showed that polygenic risk scores can predict the chance of developing a second breast cancer, with the difference between patients at either end of the polygenic spectrum demonstrating as much as a 10% variation in risk.

"These polygenic risk scores were originally developed to try to better predict the risk of developing a first breast cancer. Our research suggests that they can also be used to help patients who have survived their first breast cancer to better understand their level of risk for a second breast cancer. We hope these findings will add to the existing knowledge about predicting risk for a second breast cancer in these survivors" explained Dr van den Broek.

Chair of the EBCC calls for men to be included in trials to find more appropriate treatments

Professor Robert Mansel, Chair of the 11th EBCC, has called for men to be included in trials to improve treatments for male breast cancer. New research presented by Professor Isabel Rubio at EBCC demonstrated that radical surgery could be avoided if women were pre-treated, shrinking tumours before surgery. The study analysed women with HER2 positive breast cancer who were given targeted drug treatment before surgery, reducing the extent of resection, which led to fewer long-term side effects and an improved quality of life.

Prompted by these results, Professor Mansel said "These findings could apply to men also, but we just don’t know because men with breast cancer are almost never included in clinical trials. We need trials to start including men so that we can discover whether or not they respond in the same way to targeted treatments as women. They may not because the hormones involved in the cancer are different, but until this is investigated in trials, we do not know what is the best treatment for them."

Breast cancer is 100 times less common in men than women meaning that many treatments don’t take into account male’s differing physiology. Efforts are being made to rectify the situation, with the European Organisation for Research and Treatment of Cancer, the Breast International Group and the North American Breast Cancer Groups coordinating to analyse clinical data from a prospective international registry of male breast cancer patients. The aim is to make it easier to include these patients in future trials, describe patterns of care, and assess sample collection rate.

Women with DCIS at lowest risk of recurrence if they are post-­menopausal or have oestrogen receptor positive cancer

Ductal carcinoma in situ (DCIS) is a non-invasive form of breast cancer that develops within the milk ducts but has yet to invade neighbouring tissues. Prognosis is generally good with a very low mortality rate, however, once treated the cancer can reoccur, with 50% of these being more invasive forms of the disease.

A new study led by Dr Icro Meattini offers clues as to which patients require more aggressive treatment for DCIS to prevent aggressive recurrence, and which patients could safely have less aggressive treatments as their DSIS is unlikely to recur. Dr Meattini said "Although we know that very few patients [with DCIS] will go on to develop invasive cancer, we don’t know which ones they will be and so we offer treatments such as surgery and radiotherapy, and sometimes hormone therapy. We wanted to look in detail at women treated for DCIS to see if there are any clues about who is most at risk of a recurrence, and to understand the risks and benefits of different treatments."

Dr Meattini and colleagues studied 1,072 DCIS patients treated at nine hospitals in Italy from 1997‒2012. They discovered that patients who were post-menopausal when diagnosed, or had oestrogen receptor positive cancer, had a significant reduction in recurrence when compared to pre-menopausal women. Being post-menopausal and having oestrogen receptor positive cancer carried the lowest risk of recurrence, with the study suggesting that these conditions effectively halved the risk of recurrence.

Dr Meattini added "Now we need to do more research to find out if lower-­risk patients can safely be given less treatment or even no treatment, as well as studies on how best to treat higher-­risk patients. In the meantime, it’s vital that each patient receives treatment that is best suited to their individual cancer and their particular circumstances."

Resources & further reading

EBCC 2018 – The multidisciplinary approach to breast cancer care

The 11th European Breast Cancer Conference

ESMO Clinical Practice Guidelines – Breast Cancer

NICE Breast Cancer Guidelines

Visit the Communicating Metastatic Breast Cancer Learning Zone

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