What’s new in breast cancer?

Patsy Westcott / 26 September 2017

The latest breast cancer treatments, tests and ways to protect yourself.

At least four out of five of the 55,000-plus people who get breast cancer this year will be over 50. Thankfully, the disease is not quite the grim prospect it was.

‘Earlier diagnosis, more tailored treatments and greater understanding of underlying biology mean the outlook is improving all the time,’ says Professor Andrew Tutt, head of breast cancer research at the Institute of Cancer Research.

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To mark Breast Cancer Awareness Month, here are some of the big developments.

New breast cancer drugs

The discovery that breast cancer is as many as ten different diseases has led to a golden age of drug discovery...

The discovery that breast cancer is as many as ten different diseases has led to a golden age of drug discovery and a raft of new smarter, kinder drugs with fewer side effects. Within the past few months, NICE has given the thumbs up to Perjeta (pertuzumab) for some patients with HER2‑positive breast cancer, and Kadcyla (trastuzumab emtansine). Both drugs are designed to prevent breast cancer spreading.

A new class of drugs, CDK4/6 inhibitors, which turn off enzymes that trigger proliferation of cancer cells, holds huge promise. One of them, palbociclib, though not yet available on the NHS, has been found to help delay the spread of the most common form of the disease, ER-positive, which is fuelled by oestrogen. 

Another drug, olaparib, was recently found in trials to slow progression of advanced breast cancer in women with inherited mutations in BRCA1 and 2 genes for almost twice as long as standard chemotherapy.

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Fresh thinking about breast cancer treatment

Until recently, standard practice was to launch the equivalent of a nuclear arsenal on breast cancer: surgery, chemotherapy and/or radiotherapy, potentially causing side effects such as fatigue, red skin, hair loss, swelling and damage to the bones or heart. Thanks to better understanding of underlying mechanisms, however, many experts now argue for, as Professor Tutt puts it, ‘de-escalating treatments for some, while escalating them for others’.

So, while some tumours may still necessitate going in with all guns blazing, others may respond to gentler or even no treatment. Currently, women with ductal carcinoma in situ (DCIS), abnormal breast cells in a milk duct detected on mammogram, for example, are usually treated for full-blown breast cancer. DCIS, however, can remain harmlessly in the ducts without causing problems. Some doctors and patients are opting for a ‘watch-and-wait’ policy – having regular tests to monitor whether the disease progresses and only then deciding to treat.

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New generation tests for breast cancer

Thanks to new insights into how genes inside breast cancer cells behave, doctors are able to use increasingly sophisticated ‘genomic’ testing to predict the likely course of the disease. This involves analysing a sample of the tumour.

Last year, for instance, a new test called EndoPredict – which is available only privately – was found to be more accurate, cheaper and faster at predicting the likelihood of a recurrence within ten years than the currently used NHS test. Combined with other information about the make-up of a tumour, genomic tests can spare those at low risk of recurrence from potentially gruelling chemotherapy and other invasive treatments.

Genomic tests are not to be confused with genetic testing, which involves analysing blood or saliva for faults in DNA inherited from our parents, such as the BRCA1 gene made famous by Angelina Jolie.

Genetics and breast cancer

Less invasive surgery and radiotherapy for breast cancer

Lumpectomy as opposed to mastectomy (breast removal) has long been an option for many women. And now other, even more breast-sparing techniques are becoming part of the armoury of weapons against the disease. These include the option of removing just a few lymph nodes in the armpit to which breast cancer may have spread, rather than all of them, so helping to minimise the risk of the uncomfortable and sometimes painful arm swelling – lymphoedema – that can strike weeks, months or even years after surgery.

Meanwhile, last year researchers from London’s Institute of Cancer Research discovered that in early breast cancer, following surgery, a new type of radiotherapy – intensity modulated radiotherapy – beamed around only the part of breast containing the tumour is just as effective as irradiating the whole breast. It also has fewer longer-term effects such as breast shrinkage, lumpiness and soreness, which can affect quality of life and self-esteem.

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Better support for those living with breast cancer

As more and more women now survive breast cancer, so the need for new ways to support them through treatment and beyond increases. Breast Cancer Now is supporting researcher Professor Deborah Fenlon to look into how best to deliver cognitive behaviour therapy (CBT) to reduce the impact of two major side effects of breast cancer treatment: hot flushes and night sweats. Seven out of ten women treated for breast cancer experience these symptoms, which can affect their jobs, relationships and overall quality of life to such an extent that some even abandon treatment.

Breast Cancer Care, meanwhile, recently launched an app, BECCA, short for Breast Cancer Care App. Looking like a deck of cards, it offers tips on exercise, diet, hobbies and mental wellbeing, helping to inspire patients to regain confidence and move on with life once treatment is over.

Protect yourself from breast cancer

What causes breast cancer?

The disease results from a combination of genes, age, environment and lifestyle choices. Faulty genes account for 5-10% of cases. Dense breasts consisting mainly of glandular tissue increase the risk too. Meanwhile, 27% of preventable breast cancers are linked to lifestyle and environmental factors. Alcohol consumption, exposure to oestrogen (including the Pill and HRT) or X-rays, gaining weight as an adult, and percentage of body fat all increase risk.

Earlier this year, a major report found that drinking the equivalent of a small glass of wine or beer a day boosts breast cancer risk pre-menopausally by 5% and by 9% post-menopausally.

Recent Canadian research, meanwhile, found that physical activity has the biggest effect on reducing the risk of breast cancer recurrence or death, adding weight to previous studies. In fact, according to the World Cancer Research Fund, an estimated two in five breast cancers in the UK could be avoided by three simple steps: maintaining a healthy weight, being physically active and not drinking alcohol.

Cutting your risk of breast cancer

The importance of diet for breast cancer

US researchers recently found that a higher intake of isoflavones - plant chemicals with oestrogen-like properties that are mainly found in soya-based foods - is linked with a lower risk of dying in women with aggressive, harder-to-treat hormone-receptor-negative breast cancers, as well as women not treated with hormone therapy. Hormone receptors are proteins, found in and on breast cells, that detect hormone signals instructing the cells to grow.

It’s not known whether soya foods benefit women with other types of breast cancer or those treated with hormone therapy, so talk to your doctor before making dietary changes.

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Liquid biopsies for advanced breast cancer

Scientists are currently trying to pinpoint ways to improve detection and treatment for women with advanced breast cancer (cancer that has spread beyond the breast) by analysing DNA released by their tumours. This is done with a simple blood test, called a liquid biopsy.

Researchers from London’s Institute of Cancer Research are currently recruiting women with advanced breast cancer from across the UK for a trial. It aims to discover whether, in future, liquid biopsies could spare people from the invasive tissue biopsies currently used, as well as enabling the prescription of drugs tailored to them. First results are expected in 2018.

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