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Q3 / 2020
BREAST HEALTH Full campaign on www.healthawareness.co.uk
“It’s as simple as TLC; Touch, Look, Check” Baroness Delyth Morgan CEO, Breast Cancer Now
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“I thought cancer was well and truly behind me” Christine O’Connell Breast Cancer Patient
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“Early diagnosis saves lives” Clare O’Neill Healthcare Engagement Coordinator, CoppaFeel!
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IN THIS ISSUE
04
Thousands affected by breast cancer impacted by pandemic
“My hope is that one day, we will be able to say cancer is a chronic disease that you can live with”
The coronavirus outbreak continues to be an extremely difficult and uncertain time for so many people affected by breast cancer.
Christine O’Connell Breast Cancer Patient
04 “Your GP still wants to hear from you if you have any concerns about changes to your chest”
N WRITTEN BY
Baroness Delyth Morgan Chief Executive, Breast Cancer Now, The Research and Care Charity
Clare O’Neill Healthcare Engagement Coordinator, CoppaFeel!
06
“Liquid biopsies could be a better way of guiding treatment than standard tissue biopsies” Professor Nicholas Turner Professor of Molecular Oncology, The Institute of Cancer Research Project Manager: Jordan Bedford Email: jordan. bedford@mediaplanet.com Business Development Manager: Josie Mason Content and Production Manager: Kate Jarvis Managing Director: Alex Williams Head of Business Development: Ellie McGregor Digital Manager: Jenny Hyndman Designer: Thomas Kent Content and Social Editor: Harvey O’Donnell Paid Media Strategist: Ella Wiseman Mediaplanet contact information: Phone: +44 (0) 203 642 0737 E-mail: uk.info@mediaplanet.com All images supplied by Gettyimages, unless otherwise specified
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early one in three cancers diagnosed in women in the UK are breast cancers, with around 55,000 women and 370 men diagnosed each year. The coronavirus outbreak is having major impacts on the lives of thousands of people affected by breast cancer. We must ensure patients whose appointments, screening and treatments have been delayed - either to help reduce their risk of infection or as the NHS tried to cope with demands during the outbreak - are seen as soon as possible. At Breast Cancer Now, the research and care charity, we are here to support patients and their families through whatever they’re facing, now more than ever. The importance of breast awareness Many women have been concerned or uncertain about getting possible breast cancer symptoms checked out during the pandemic, but it’s so important everyone continues to check their breasts regularly and gets in touch with their GP if they notice anything different or new. Signs and symptoms can include a lump, nipple discharge, or dimpling or puckering of the skin of the breast. Checking your breasts only takes a few minutes, just remember to check the whole breast and the surrounding area, including the upper chest and armpits. There’s no special way, it’s as simple as TLC; Touch, Look, Check. We must ensure that anyone with unusual breast changes feels safe to come forward and to speak to their doctor. While most breast changes
won’t be breast cancer, the sooner the disease is diagnosed, the more likely treatment is to be successful. New research during the outbreak It’s crucial that we continue to consider new ways to guide the best possible treatment for breast cancer patients during the pandemic, while minimising the risks of the virus. Thanks to research, we can now identify patients with a specific type of breast cancer who must be prioritised for surgery or chemotherapy urgently, and those who could safely be given hormone therapy to delay further treatment during the pandemic. The pandemic has unfortunately put a lot of lab-based breast cancer research on hold. However, as labs across the country start to reopen, we hope they can return to normal capacity as soon as possible to continue their life-changing work. Support in a new way As the UK’s first comprehensive breast cancer charity, we’re determined to make sure anyone affected by breast cancer continues to receive the support and information they need, the whole way through this crisis and beyond. We are offering new online support with our Moving Forward end-oftreatment courses and a Living with Secondary Breast Cancer programme for those with an incurable diagnosis. We have also extended our Someone Like Me service for people with a primary diagnosis to provide one-to-one support for people feeling isolated or anxious as a result of the pandemic crisis.
For information about breast cancer or Breast Cancer Now’s world-class research or life-changing care, visit breastcancernow.org Anyone can call our free Helpline on 0808 800 6000 for information and support – our nurses are just at the end of the phone.
Read more at healthawareness.co.uk
At Cancer Centre London, we understand that a cancer worry can turn your life upside down. From the moment you are diagnosed through to treatment and recovery, we are here for you, every step of the way.
Call 020 3883 6112 / 020 3432 6542 Email opd@cancercentrelondon.co.uk Visit cancercentrelondon.co.uk CCL438-SEP20-V1
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Oncotype DX® test predicts chemotherapy benefit Chemotherapy is often recommended for breast cancer patients, even though not all individuals benefit. Genomic testing can help determine whether the treatment is needed.
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The Oncotype DX® test provides patients with additional information about the chance of breast cancer coming back and likely benefit of chemotherapy.
Chemotherapy challenges Currently in some areas of the UK, there is a backlog of breast cancer treatment in part due to reduced staffing levels and increased patient safety measures during COVID-19. With the potential that patients could be more advanced on first diagnosis due to the delay, Dr. Simcock believes that additional genomic testing could improve patient confidence, whilst also reducing the chemotherapy burden on the NHS. He said, “Chemotherapy is a field which requires a highly specialised team. Given that many NHS staff have been redeployed to other areas during the COVID-19 pandemic, knowing whether someone could actually benefit from chemotherapy treatment or not would greatly free up resources.”
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atients diagnosed with breast cancer in the UK will be assessed and treated by a multi-disciplinary team, where surgeons, specialist oncologists and nurses offer advice on individual patient care. The Oncotype DX® test provides patients with additional information about the chance of breast cancer coming back and likely benefit of chemotherapy through a score derived from the individual’s tumour either at core biopsy, or after surgery. In addition to relying on population based estimates, the results of the Oncotype DX® test are entirely individual. Combining these different pieces of information means patients and clinicians can put together a treatment plan that outlines the chance of breast cancer recurrence, and the individual patient’s likely benefit from chemotherapy. As Dr. Richard Simcock, Consultant Clinical Oncologist at the Sussex Cancer Centre explains, communication is key when outlining a patient’s prognosis: “Surgeons deal with certainty, but oncology is founded on uncertainty, only reduced through information. The Oncotype DX® test enhances this certainty by giving a clear indication of the chance of recurrence and the patients’ individual benefit of chemotherapy.”
Patient perspective These results can help patients make much more informed decisions. This was certainly the case for 50-year old Jane who had her cancer picked up on a routine mammogram. Although there was no prominent lump to be found, shortly after her core biopsy the cancer was confirmed. In the consultation room Jane had many questions, hoping to fully understand her diagnosis and her choices. As one of the first treatment steps, she had her operation with analysis showing that her cancer had only spread to one lymph node. “I was incredibly lucky” said Jane. “Not only with my cancer being caught early, but also with it only spreading to one node. I was lucky for a third time when my consultant mentioned Oncotype DX®.” Within two weeks, Jane had the news she was waiting for. She said, “My family viewed the cancer pragmatically, but we knew that treatment during my daughter’s exams would be chaotic. Finding out that I had a low score and did not need chemotherapy was a godsend.”
Communication through COVID-19 While traditionally, patient communications have been face-to-face, new procedures due to COVID-19 have changed the dynamics. Dr. Simcock explains, “The first thing a consultant needs to do with a patient is listen, as they may have their own reasons to continue down a particular care path. With conversations now taking place via phone or online where nuances can get missed, it is more important than ever that patients feel they are in control. By having a defined breast cancer recurrence score, patients feel that their care is tailored to them and not just aggregated into population data.” While there are further considerations to be made as to whether the Oncotpye DX® test is suitable for different patient groups, such as those whose cancer has spread to the lymph nodes, Dr. Simock hopes that by building an individual risk profile through genomic testing, the test could potentially reduce the burden of chemotherapy on the service. He hopes that the Oncotype DX® test will continue as a standard diagnostic tool for the NHS, increasingly important considering the challenging situation presented by COVID-19.
INTERVIEW WITH
Dr. Richard Simcock Consultant Clinical Oncologist, Sussex Cancer Centre, and Jane, a breast cancer patient from Somerset
WRITTEN BY
Gina Clarke
Read more at oncotypeiq.com/en-GB
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Young people are not routinely screened and are often overlooked when it comes to breast cancer information.
Breast cancer does not stop for COVID-19 Breast cancer remains the most common cancer in women in the UK. Despite COVID-19, people should be presenting themselves to their GP to get symptoms checked.
WRITTEN BY
Clare O’Neill Healthcare Engagement Coordinator, CoppaFeel!
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020 has us all thinking about our health, and, at CoppaFeel!, we know that cancer doesn’t stop for COVID-19. In fact, breast cancer remains the most common cancer in women in the UK. Early diagnosis saves lives – having been diagnosed myself at 33, I know that all too well. I noticed symptoms, got diagnosed early and am now in remission, so I know the importance of breast awareness. During this pandemic, our message is more crucial than ever. We’re concerned that people haven’t been presenting to their GPs to get symptoms checked, and this is something the NHS and cancer charities are trying to rectify. Our work to support people with breast cancer Our charity is dedicated to ensuring that young people are informed and proactive about breast health. Young people are not routinely screened and are often overlooked when it comes
to breast cancer information. It’s our mission to ensure they’re educated on the signs and symptoms, encouraged to self-check regularly and empowered to seek medical advice without delay if they spot something unusual for them. Our advice if you notice changes to your breasts We know these last few months have left people unsure and confused, so we’re here to tell you that your GP still wants to hear from you if you have any concerns about changes to your chest. There might be fewer physical appointments, but the use of virtual appointments may mean it’s more convenient to speak to your doctor. Here are our tips for your GP appointment: 1. If you would rather a male/female GP, you can request that when you book. 2. Ask a family member/friend to be with you for support.
PURSUING EARLIER DETECTION AND LIFE-CHANGING ANSWERS
3. Write down any questions beforehand. 4. Jot down when you first spotted the symptom(s), to tell the doctor. 5. If you have periods, make a note of when your last one was, as the GP might ask. 6. Recall any family history of breast cancer, as the GP might ask you about that too. We all have breast tissue, young, old, guys, gals and non-binary pals – so we should ALL get to know our chests by checking regularly. You know your body better than anyone, so, if you are worried about an unusual change, trust your instinct and book an appointment. It might feel embarrassing or unnecessary, but believe me: It could save your life.
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How to help your body recover from breast cancer through walking When Nina Barough was diagnosed with breast cancer, it came as a shock – mainly because she didn’t feel ill.
I
INTERVIEW WITH
Nina Barough CBE Founder and Chief Executive of breast cancer charity Walk the Walk WRITTEN BY
Gina Clarke
ronically, just a few months earlier, she had gathered together a group of friends to walk a marathon in decorated bras, raising thousands of pounds for research into breast cancer. After her own diagnosis in 1997, walking regularly and keeping fit became her mantra. Nina says: “Before I went into hospital, I really concentrated on both my diet and my health. I thought that if I could get as fit and as healthy as possible, I would be in a better position to recover from my treatment. While her breast cancer charity, Walk the Walk, encourages walking challenges to suit different abilities, Nina says her walking starts as soon as she gets out of bed in the morning. “It’s hard to hear that people give up wearing a fitness tracker, because of the pressure of trying to hit 10,000 steps a day. I strongly feel that if we all aim for two miles a day as a minimum, it’s more achievable and will encourage people to grow their goals from there. Miraculously, I can do two miles a day just doing my housework! The benefits of walking at speed became obvious The benefits of walking soon began to feel obvious, especially when it was
part of Nina’s daily routine. What’s more, it seems that the medical profession agrees. For healthy people, walking is advocated as a great, low-impact activity that, if done at a faster pace (i.e. power walking), can get your heart pumping and oxygenate your lungs. Walking’s good for the heart, bone density, symptoms of the menopause and for the mind – the benefits are endless. It’s the perfect exercise. While there was no advice given to take up walking during her breast cancer treatment, Nina could feel for herself the benefits both mentally and physically, and it really set the path for her future. “It definitely helped me through,” she says. “And, now, I often schedule time in my diary so that I create space for a daily walk – it sets me up for the day.” A sense of achievement What’s more, the benefits of walking aren’t just physical. A regular walk has
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been found to be great for mental health and reducing stress. Trying different routes, pace and types of walking will keep it varied and interesting. Slower, more meditational walks are better on some occasions – at other times people will want to achieve a personal best. While some may thrive on endurance and speed challenges and more physical activities, Nina believes that you can achieve real joy from all types of daily walking, no matter what your personal goal is. She says: “Of course, as well as all the physical and mental benefits, taking on marathon walking challenges throughout the UK or the world has been an added bonus – and can allow you to discover so many new and wonderful places. The truth is, though, whether we want to hit a target or just get fit, walking is the perfect solution”
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To find out more about Walk the Walk’s events, go to walkthewalk.org
We all have breast tissue, young, old, guys, gals and non-binary pals – so we should ALL get to know our chests by checking regularly. ~ Clare O’Neill, Healthcare Engagement Coordinator, CoppaFeel!
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A blood test to detect the earliest signs of breast cancer
“I take my pill every day, and I get on with my life” Targeted treatments are helping cancer patients live longer and with a better quality of life. Christine O’Connell lives with advanced breast cancer and takes a new class of targeted cancer drug with fewer side effects than chemotherapy.
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In December 2012, I went to my doctor about a pulled muscle. It turned out to be a seven centimetre tumour in my left breast. It felt as if a huge tornado had swept through my life. I went through chemo, then a mastectomy and radiotherapy. The treatment was just exhausting. I couldn’t think straight; I lost my hair, my appetite and had to stop working. But, after intensive treatment over nearly a year, I had no evidence of disease. Nearly five years after my diagnosis, I thought cancer was well and truly behind me. Then, in February 2018, I was cycling into London for a meeting when I had a seizure and collapsed. A scan confirmed that the breast cancer had returned and had spread to my brain. I was in total shock – it was hard to accept that I was facing an incurable disease that could progress at any stage. Following surgery and a targeted form of radiotherapy, I needed a new drug treatment regime to keep my cancer at bay. Fortunately, a new class of targeted cancer drug had been approved for use on the NHS just months before, following UK trials led by the Institute of Cancer Research, London. Currently my cancer is stable. I take my pill every day, three weeks on, one week off, and I get on with my life. I’m in the clinic just once a month to have my bloods checked and I have scans every three months to check the status of my disease. I cycle 200-300km a week – which I could never have done had I been on conventional therapy – and it’s become my lifeline. I know at some point my current treatment will stop working, and my cancer will progress because it will have developed a resistance to the drug. At that point, I hope there will be more new treatments in the pipeline that will buy me more time. I use my passion for cycling as a means to raise awareness and funds for research into secondary breast cancer through the One More City campaign, which supports research at the Institute of Cancer Research (ICR). Cancer research is progressing at such a speed, but we need to stay one step ahead to improve and extend the lives of patients like myself with advanced disease. My hope is that one day, we will be able to say cancer is a chronic disease that you can live with.
A liquid biopsy involves taking a blood sample from a cancer patient before, during and after a course of treatment. Testing for cancer cells and cancer DNA in the bloodstream is showing huge promise as a way of monitoring breast cancer and how it responds to treatment – helping guide clinical decisions.
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esearchers at The Institute of Cancer Research, London, have pioneered the development of so-called ‘liquid biopsies’ – blood tests that can detect the spread of cancer more quickly than other current methods. These blood tests look for cancer cells and tiny pieces of cancer DNA that are circulating in the blood. In this way, liquid biopsies can detect the return of breast cancer after treatment before patients develop symptoms or secondary tumours become visible on scans. This enables researchers and clinicians to identify the earliest signs of relapse before the patient clinically relapses, which they hope will improve patient outcomes by staying one step ahead of cancer. More efficient and less painful for patients Professor Nicholas Turner is Professor of Molecular Oncology at The Institute of Cancer Research (ICR) and Head of the Ralph Lauren Centre for Breast Cancer Research at The Royal Marsden NHS Foundation Trust. As a Team Leader in the Breast Cancer Now, Toby Robins Research Centre at the ICR, he specialises in the use of liquid biopsies to deliver more precise treatment for breast cancer patients, leading many national and international trials. “Liquid biopsies look for tumour cells or DNA in the bloodstream and represent a major step forward in our ability to monitor a cancer and how it responds to treatment,” he explains. “Previously, the only way to get detailed genetic information about tumours was to take a tissue biopsy either during surgery or through the use of a needle – and because that can be painful for patients, there is a limit to how many times it can be done.” Faster insights into the effectiveness of treatments Liquid biopsies can act as a biomarker –
WRITTEN BY
©FOTODUETS
Christine O’connell Breast cancer patient
a biological measure – to indicate whether treatment is working and how a cancer is responding. To effectively treat cancer and prevent it from coming back, spotting when drugs have stopped working is key. By detecting the earliest signs of relapse, liquid biopsies may indicate when a patient needs to change to another drug. By analysing the genetic changes in the tumour DNA found in the blood, researchers and clinicians can also pick out patients who may be particularly likely to respond to certain drugs or who are likely to relapse after initial treatment – enabling them to select and target further treatment at those who would benefit. “We are already showing that liquid biopsies are not only giving us new insight into how cancer develops – they are already starting to improve treatment by guiding clinical decisions, leading to better outcomes for breast cancer patients. In fact, they can even help us match patients to certain treatments.” Opening abilities to match patients more precisely to treatments “Our ongoing plasmaMATCH trial looks at identifying mutations in metastatic breast cancer of individual patients to try to match them to specific targeted treatments. Initial results are promising and have already shown that genetic changes in a small group of breast cancer patients could be targeted with certain drugs, suggesting that liquid biopsies could be a better way of guiding treatment than standard tissue biopsies.” Liquid biopsies are simple blood tests which are being tested in many other clinical trials too. Despite still being evaluated in the laboratory and the clinic, these tests are likely to be introduced more widely in cancer management in the future. Hopefully in a not too distant future, liquid biopsies will replace standard, invasive biopsies and help improve treatment for breast cancer patients.
WRITTEN BY
Professor Nicholas Turner Professor of Molecular Oncology, The Institute of Cancer Research
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Rethinking breast cancer research and funding
Paid for by Breast international group
As knowledge about breast cancer and its various subtypes grows, we need to rethink established research and funding models to ensure progress continues.
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ver the past 40 years, thanks to advances in treatment, teamworking in the delivery of treatment, and technology, breast cancer survival rates have doubled in the UK and most Western countries. The recognition that breast cancer is not a single disease, but rather multiple diseases, has been key in driving progress.
INTERVIEW WITH
David Cameron MD, PhD BIG Chair, Professor of Oncology and Clinical Director, Edinburgh Cancer Research Centre
WRITTEN BY
Kate Sharma
We need to go global to find enough patients for research “If you want to pick up a group of patients with an uncommon subtype, then you will not find enough in any one country to do a study in a meaningful length of time,” explains Dr David Cameron, Chair of Breast International Group (BIG) and Professor of Oncology and Clinical Director of the Edinburgh Cancer Research Centre. BIG, an international not-for-profit organisation that represents the largest global network of academic research groups dedicated to finding cures for breast cancer, is looking to overcome this challenge by working with over 55 like-minded research groups tied to several thousand specialised hospitals, research centres and world-class breast cancer experts across the world. Through this collaborative approach, BIG aims not only to increase the pool of patients, but also tap into global medical expertise. “Over the years there has been increasing alignment in the way that different countries treat breast cancer, which is helping to smooth the pathway to greater collaboration,” says Cameron. Financial viability Of course, patient numbers aren’t the only figures that need to be balanced. Pharmaceutical companies often fund trials but, as Cameron observes, “there is no commercial incentive for a company to develop a drug for a very small group of patients with a rare cancer subtype. Equally, there is no return on clinical trials for drugs that are already out of patent.” “We’ve got a study going on (called POSITIVE, also known as BIG Time for Baby) to see whether you can stop your breast cancer treatment to get pregnant. It’s a critically important question – but such studies aren’t commercially viable,” continues Cameron. “That’s why we need more academic research and we need more funding models to answer these questions.”
BIG has also just finalised enrolling 1,000 patients into a research programme that will study the evolution of metastatic breast cancer (called AURORA, or BIG Metastatic Breast Cancer GPS). The knowledge gained will provide a bedrock of data that will hopefully inform diagnosis and treatment. Patient voices are vital in effecting change Patient care can’t be compromised and it’s vital that patients contribute at every stage of clinical trials, from planning to completion. Patient advocates will play a key role in events taking place as part of Pink October – a month dedicated to raising awareness of breast cancer – where the theme of de-escalation of treatment will feature highly. During a webinar taking place on October 14, breast cancer experts will focus on the growing importance of treatment de-escalation. By safely avoiding unnecessary over-treatment, this may help to reduce negative side effects and improve breast cancer patients’ quality of life. Registration to the webinar is free and mandatory: www.eortc.org/webinar_de-escalation_ breast_cancer_treatments/ As we learn more about the genomics of breast cancers and the way they behave, treatments are becoming more targeted. Patients can achieve the same or even better outcomes while being spared some of the aggressive chemotherapy or radiotherapy options and the unpleasant side effects that they cause. This is good news for patients. However, more than 600,000 individuals worldwide (source: GLOBOCAN 2018) continue to lose their lives to the disease each year. There is still much left to learn, and research and trials are key to supporting the millions of women, and men, affected by breast cancer. Support BIG About 95% of BIG’s revenue is spent directly on research conducted under the BIG umbrella. Donate online: www.BIGagainstbreastcancer.org/donate
@BIGagainst breastcancer @BIGagainstbc BIG against breastcancer Read more at bigagainstbreast cancer.org
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With the right treatment for secondary breast cancer, you can keep doing what matters most. Discover more about secondary breast cancer. whatsbreastforme.co.uk
The What’s Breast for Me? campaign is initiated and funded by Pfizer Limited. This advert is intended for residents of the UK. The information provided within the website is intended for general information and education and is not intended to be a substitute for advice provided by a doctor or other qualified healthcare professional. All decisions regarding patient care must be made with a healthcare provider, considering the unique characteristics of the patients. Š 2020 Pfizer Limited | PP-ONC-GBR-1610 Date of preparation: September 2020