Breast Health UK Q3 2019

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DR CAROLINE RUBIN, RCR Following routine breast screening most women get an ‘all clear’ letter. » p4

DAN MARSH, BAAPS Some women with breast cancer don’t know what choices are available. » p6

JANE DEVONSHIRE, MASTERCHEF WINNER It was liberating to win because of my cooking.

My illness was irrelevant. » p10

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Rising to the challenge of breast cancer, together Every 10 minutes, one woman in the UK is told she has breast cancer. We must act now to ensure that, by 2050, everyone who develops the disease will live and live well.

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reast cancer is a devastating reality for one in eight women in the UK. More women than ever before are being diagnosed, and around 1,000 still die from the disease every month.

Our ambition is that, by 2050, everyone diagnosed with breast cancer will live and be supported to live well. But we need to act now - from funding more world-class research, to ensuring more people get the support they need.

Prevention and breast awareness One of the best lines of defence we have against breast cancer is to prevent the disease occurring in the first place.

There is never one single cause of

breast cancer, but rather it results from a combination of our genes, the surrounding environment and the way we live our lives.

S o it 's c r u c i a l e ve r yo n e i s supported to take steps to keep their risk as low as possible, including drinking less alcohol, maintaining a healthy weight and keeping physically active. Even small changes – like walking more or cutting down on processed foods – can be a great start.

Breast cancer remains the most common cancer in the UK, so we need to ensure more women are breast aware and are checking themselves regularly, as the earlier the disease is detected, the more successful treatment is likely to be.

Getting to know your breasts and what's normal for you means it's

WRITTEN BY: BARONESS DELYTH MORGAN Chief Executive, Breast Cancer Care and Breast Cancer Now

11,500 women and 80 men lose their lives to breast cancer each year.”

with secondary breast cancer in the UK who carry BRCA gene mutations - but we need to see even more progress.

easier to spot anything unusual, like a lump or change in skin texture, so you can get it checked out by your doctor. There's no special way, it's as simple as TLC: Touch, Look, Check.1

Support beyond treatment For the majority of women, the impact of breast cancer doesn’t stop when treatment ends. The ongoing physical or emotional effects can make adapting to life after treatment a huge challenge, and we must do more to ensure people can connect with support that meets their needs.

Anyone can call our Helpline on 0808 800 6000 to speak to our nurses or discuss other support available, including our end-of-treatment Moving Forward courses.2 By uniting to create the UK's first comprehensive breast cancer

Research into PARP inhibitors and treatment With around 11,500 women and 80 men still losing their lives to breast cancer each year, we urgently need to find ways to treat the disease more effectively at every stage.

Thanks to pioneering research, new drugs called PARP inhibitors could soon offer an option to patients

charity, Breast Cancer Care and Breast Cancer Now can better serve a growing community of people living with the life-long impact of breast cancer, and make the research breakthroughs to help give women more time to live, and live well.

We must rise to the challenge of breast cancer together and we must do it now.

Anyone can call our helpline on 0808 800 6000 to speak to our nurses or discuss other support available, including our end-of-treatment Moving Forward courses.2

1: breastcancernow.org/about-breast-cancer/want-to-know-about-breast-cancer/what-are-the-signs-of-breast-cancer 2: www.breastcancercare.org.uk/information-support/support-you/moving-forward-after-breast-cancer-treatment

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Doctor’s perspective:

Patient story:

The test that helped my breast cancer decision A genomic test helped Liz Lightstone make a better-informed decision about whether to have chemotherapy for her breast cancer.

Having the Prosigna test helped make the right decision for me. Not having chemotherapy means I will get my life back faster.”

INTERVIEW WITH:

LIZ LIGHTSTONE Breast cancer patient

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hen Liz Lightstone found a lump in her breast in June this year, she “just knew” it was cancer. However, as a Professor of renal medicine at Imperial College London, Liz wanted as much medical information as possible when making treatment decisions.

“Tests confirmed I had very early-stage breast cancer,” says Liz. “I was pretty confident because it was caught early and was well-understood. I told everyone right away.”

Liz’s cancer was classed as hormone receptor positive HER2 negative, where the cancer may grow more slowly and is less likely to recur after treatment.

However, Liz says: “Mine was a low-risk cancer. I did not want chemotherapy if it was would not make much difference to my personal risk of recurrence.”

She decided to use the Prosigna test, which predicts an individMEDIAPLANET

ual patient's ten-year risk of recurrence. She says: “It’s particularly suitable for women with early-stage hormone receptor positive HER2 negative breast cancer and is being indicated for node-positive patients as well - like me. It allows for personalised medicine, cutting the risk of over- or under-treatment.”

Her personalised score indicated t hat her t u mou r w a s of good prognosis and of a molecular type, allowing chemotherapy to be spared.

The results helped Liz decide against chemotherapy.

Even without chemotherapy, her life has been affected more than she expected. “I usually combine research with spells of clinical work on renal wards. I had decided to leave out the ward sessions this year, even before my diagnosis - just as well, as I couldn't have done it,” she says.

“The tests, medical appointments and treatment dominate your life. I can't remember anything else about June and July. I'm having radiotherapy now and thought I could work throughout, but it leaves me so tired, it's a race to get to bed before falling asleep.”

Liz adds: “Having the test helped make the right decision for me. Not having chemotherapy means I will get my life back faster.”

Anyone being treated for breast cancer can mention the availability of Prosigna in the UK to their oncologist, surgeon, or nurse.

WRITTEN BY: LINDA WHITNEY Read more at nanostring.com/diagnostics/ prosigna-uk

Patient choices in breast cancer care are growing: this is what you need to know As advancements in healthcare have grown, patients are gradually seeing more choice in their treatment for breast cancer. Ensuring patients fully understand their options is the issue many professionals now face.

While breast cancer is an emotional emergency, it is not a medical emergency. You do not have to make a decision straight away.”

INTERVIEW WITH:

PROFESSOR DAME LESLEY JEAN FALLOWFIELD

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edical advancements in breast cancer have been well documented, and patients are finding themselves at the cusp of personalised healthcare.

But, just like people, tumours do not always behave as expected.

That is why many oncologists are turning to genomic testing to tailor a course of treatment.

Th i s new w ay of prac t ic i ng medicine is often unexpected for the patient, who fi nd that they actually have a far wider say in their next steps than previously thought.

Women who had previously been offered chemotherapy ‘just in case’ were now being told that they may be able to opt for hormone treatment alone instead, avoiding the grueling side effects of chemo, while also saving NHS resources.

Cancer risk-factor score may not show the whole picture Previously, women were given a score based on the stage of their cancer combined with risk factors such as age, health and medical background. Until recently, clinicians used chemotherapy in patients with an intermediate risk-of-recurrence.

However, a recent study has found that aggressive treatments may be

unnecessary for a large number of women.

Instead, an additional test of the tumour known as a genomic test, can further pinpoint the most appropriate action to take.

Based on a large data set, the study found similar survival rates between those who have chemotherapy and hormone therapy and those who have hormone therapy alone and that this was particularly true for women aged over-50.

Professor Dame Lesley Fallowfield is a cancer psychologist and a professor of psycho-oncology at the University of Sussex. She has worked with clinicians on communicating with patients and the choices they face thanks to new improvements in technology.

She says: “What we’re finding is that while patients are now much better informed about the next steps, this is still a stressful and frightening time for them. That can lead to confusion and a feeling that they haven’t understood the whole situation.”

Take time after your diagnosis to research your next steps Professor Dame Fallowfield believes that, for these new opportunities to create a truly personalised pathway, there needs to be a set of guidance for both the clinician and the patient.

She says: “Patients need to realise that, while breast cancer is an emotional emergency, it is not a medical emergency. You do not have to make a decision straight away and any clinician should encourage you to make a recording of the conversation so that you can go over it at a later date. “ Take a few days to do your research, talk to people who may be in a similar situation and come back to your oncologist with any further questions.”

Workshops for clinicians to improve dialogue with patients Professor Dame Fallowfield also highlights the ‘jargon’ that many clinicians may use as standard, and has devised an away-day that aims

to share with doctors the different reactions of patients when faced with potentially new language and additional test scores.

She says: “Most doctors are good people; it’s why they entered the medical profession. So they want to know how to convey these new tests and results while giving a personalised choice of outcome. The complexities that they try to sum up may often get missed, which is why we are developing a set of exercises that oncologists can refer to. It also helps the patients to feel less anxious in a situation that is already stressful and confusing.”

A s p a r t o f h e r e i g h t- h o u r work shops, P rofes sor Da me Fallowfield has included a wide v a r iet y of element s a i me d at improving the knowledge, communication and awareness of the relationship between doctor and patient.

Through filmed scenarios and an interactive risk psychology lecture, results have already shown that a patient’s anxiety drops when a clinician communicates after attending the course.

For oncologists faced with the di lem ma of empower ing t heir patient without confusing them, Professor Dame Fallowfield says that it can be a hard road to walk without any help.

She says: “The trouble we have as medical professionals is that we want to guide patients to a sensible choice without patronising them, but we understand that chemotherapy can be incredibly challenging on a patient. If we communicate better then we can make sure that the right decision is made for everyone, every time.”

WRITTEN BY: GINA CLARKE

Sponsored by

Read more at prosigna.com HEALTHAWARENESS.CO.UK

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The tiny tags that make life easier for breast cancer patients Breast cancer patients can benefit from pioneering preop technology, says Dr Alice Leaver, Clinical Director and Consultant Breast Radiologist, Queen Elizabeth Hospital, Gateshead.

What is a radio frequency identification (RFID) tag?

Thanks to the NHS breast screening programme, increased breast health awareness and more innovative technology, we can now detect early stage breast cancers that are tiny — often too small to feel. That's good news for the patient, because small tumours are easier to treat.

However, precisely because these tumours are so small, the surgeon can have difficulty locating them when it comes to removing them.

So, the RFID tag is pioneering technology implanted into the breast of a patient to mark these tiny tumours and guide the surgeon to their location, using a hand held detector that emits radiowaves. Tags are small — the size of a grain of rice — radiation free and passive.

What was used to guide surgeons before this technology became available?

We've been inserting very thin guide wires into the patient's breast on the morning of surgery, under local anaesthetic. On the whole, wires do a good job of guiding the surgeon to the tumour. The downside is that sometimes these wires can move, which causes problems for the surgeon — plus, patients don't like the idea of a wire being inserted into them, for obvious reasons. They have to put up with it sticking out of their breast until the operation, at which time it's removed.

How have patients reacted to the RFID tag?

We've had g reat feedback. We want to do our utmost to give our patients the best experience possible because we know that this is such a traumatic time for them.

An RFID tag is a way to help them feel more relaxed and make the process easier. It can be implanted

INTERVIEW WITH:

What happens if you are called to a breast clinic?

WRITTEN BY: DR CAROLINE RUBIN Vice President, Royal College of Radiologists

DR ALICE LEAVER Clinical Director and Consultant Breast Radiologist, Queen Elizabeth Hospital at the patient's convenience, at any time in the 30 days before surgery.

When a wire is inserted on the morning of the operation, the patient can't eat or drink. With this new technology, however, patients can pop in, have the tag implanted — and then they don't have to come in so early on the day of their surgery.

Does it also make life easier for clinicians?

Tags are ver y helpf u l because they offer more accuracy for the surgeon. There's also less chance of an operation having to be cancelled because there was a problem with a guide wire. And because tags can be implanted in the days before surgery, clinicians in radiology and surgery departments are able to better organise their workflows.

Tags are slightly more expensive than guide wires, but we found they work very well and improve the patient experience. Now our Trust — the first NHS Trust to use them — is looking at whether tags can be funded long-term.

WRITTEN BY: TONY GREENWAY Read more at healthawareness.co.uk

An invitation to a breast clinic for tests can be frightening. It doesn’t always mean you have cancer, but either way, here’s what to expect at your appointment.

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any of us fear an appointment at a breast clinic, whether we have been recalled after a routine breast screening or referred by a GP. Nevertheless, it's important to go, and it helps to know what to expect.

A recall or referral does not automatically signify breast cancer.

"The majority of women attending breast clinics are not diagnosed with cancer. Most assessments reveal normal breast changes or benign conditions," says Dr Caroline Rubin, Vice President for Clinical Radiology at The Royal College of Radiologists and practising breast radiologist at University Hospital Southampton.

Following routine breast screening (usually a mammogram, a breast X-ray carried out in a mobile van) most women get an 'all clear' letter. However, about one in 25 receives a recall letter, asking them to attend a specialist breast clinic.

Only about a quarter of these women may have cancer.

Consider taking a friend Other women attend breast clinics after being referred by their GP. Among these women the cancer diagnosis rate is 2% to 3%, as most of them turn out to be the 'worried well'.

Consider telling a trusted friend or family member and taking someone (fema le or ma le) w it h you for

Following routine breast screening most women get an ‘all clear’ letter.” support. "It's encouraged, because the stress means that most patients do not remember the majority of what is said," says Dr Rubin.

If you particularly want to see female staff, ask. The clinic will try to arrange it, though it is not always possible.

What to expect at the clinic If you have been recalled following screening, you will have another mammogram, a breast examination and often an ultrasound scan too.

Depending on what is observed, you may have a biopsy, in which a needle or small cutting device is inserted, usually under anaesthetic, to take a sample of breast cells or tissue to help with the diagnosis, using imaging techniques such as X-rays or ultrasound to ensure the biopsy targets exactly the right place.

Usually, all these procedures can be done on the same day at the clinic, and none of them mean that you inevitably have breast cancer.

If you have been referred by a GP, you will go to a one-stop clinic where you will be examined by a breast surgeon or clinician and have an ultrasound and/or a mammogram. " M a ny wome n a r e r e fe r r e d

because they have found a lump, which commonly shows up on the ultrasound image," says Dr Rubin.

"In many cases these prove to be not cancer, but fluid-filled sacs called cysts, which we can drain there and then."

What you can expect your results If the imaging and clinical examination are reassuring, the results are given immediately.

If a sample is taken, you will be given an appointment to attend clinic about a week later to talk with a breast surgeon and (usually) a breast cancer nurse about your results.

"You get the results face-to-face even if you have not got cancer," says Dr Rubin. "Your diagnosis will be explained and if any treatments are required, you will be able to discuss them."

Dr Rubin adds: "Whatever the outcome, you will receive support throughout, so ensure you keep your breast clinic appointment. It could save your life."

Read more at healthawareness.co.uk

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Treatment is now as least invasive as possible, with drug therapy used where possible, to surgery focused on breast conservation and aesthetics.”

It’s time that breast cancer care got personal Having the time and expertise to care for people with breast cancer goes a long way to delivering the very best patient outcomes.

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sing the newest technology and personalising the diagnostic pathway, can increase the probability of cancer detection between 3-15%. “One in every 6 women diagnosed today with breast cancer could be accessing more innovative cancer care which could save their life. Wouldn’t you want to be that woman?” says Dr Penny Kechagioglou, Chief Medical Officer at GenesisCare.

F o u nde d to prov ide b e t ter, faster access to quality cancer care GenesisCare are investing in the latest diagnostic technology (tomosynthesis, automated breast ultrasound, breast MRI) and adopting individualised diagnostic protocols to increase accuracy of diagnostic tests, positioning itself right at the forefront of technologies and procedures to treat cancer, and in a personalised way. With appointments at evenings, GenesisCare makes access to specialist care as easy and as fast as possible, which is the most important thing to do if you are worried about your breast health. Dr Kechagioglou says: “Two weeks for a referral is a long time to wait. Any woman in this situation would want to see someone straight away.”

Around one in seven women will be diagnosed with breast cancer, making it one of the most common types of cancer in the UK. Most women diagnosed with breast cancer are over 50 but do not a have family history or genes (minority of women MEDIAPLANET

INTERVIEW WITH:

INTERVIEW WITH:

INTERVIEW WITH:

DR PENNY KECHAGIOGLOU Chief Medical Officer

SIMON SMITH Surgical Clinical Director

ELIOT SIMS Clinical Director, Breast Oncology

have familial breast cancer), factors such as a sedentary lifestyle and excessive weight are reducing the age at which breast cancer is seen.

Routine NHS breast cancer screening – mammography – is currently offered only to women aged over 50 years.

Dr Kechagioglou urges all women to examine their breasts regularly and report any symptoms. Checks should include palpation of the breast and under-arm areas for lumps and bumps, as well as a visual check for any changes in the shape of the breast or nipple. Red-flag signs include unusual breast asymmetry, dimpling of the breast skin, nipple discharge, crusting or inversion. “Around once or twice a month is enough,” says Dr Kechagioglou who advises doing your check in a warm shower about three to five days after your period starts. If you have gone through menopause,

do your exam on the same day every month.

few women now lose a breast, and good oncology and plastic surgery now go ‘hand-in-hand’, says Simon Smith, Consultant Oncoplastic Surgeon and advisor to GenesisCare.

What’s more, advances in radiotherapy have reduced the toxicity and duration of treatment, as well as the use of tell-tale treatment procedures such as tattooing.

Greater understanding of the genetics of cancer has also significantly reduced the use of chemotherapy while exercise, nutrition and mindfulness programmes – services which are all part of the GenesisCare offering – offer support that physically and mentally equips people to better manage treatment side effects, such as fatigue, and to improve their prognosis.

Developments such as t hese put specialists with the time and expertise to care for people with

Treatment options Rapidly advancing technology can support women (and the few men that also develop breast cancer) at all stages of their breast cancer journey, from more accurate screen ing (mam mog ram s) to fine-need le biopsy (sampling of the suspect tissue) and treatment.

Accord i ng to Dr E l iot Si m s, Consultant Clinical Oncologist and Breast Reference Group clinical Director at GenesisCare, over the past 25 years breast cancer survival rates at five years have risen from 50% to 80%. Treatment is now as least invasive as possible, with drug therapy used where possible, to surgery focused on breast conservation and aesthetics.

Compared to 50 years ago, very

breast cancer in a great position to deliver the very best patient outcomes. Mr Smith says: “Breast cancer is unique among cancers in that it benefits from a huge amount of public interest, it is well funded and researched. The next step is for the clinical team to focus on having honest conversations with patients about the options available to them, and for us to be able to give real consideration to what the patient wants from their treatment.”

WRITTEN BY: AILSA COLQUHOUN GenesisCare’s innovative breast cancer services in the UK include high quality screening processes, genetic testing and the very latest diagnostics techniques. Their One Stop Breast clinics offer flexible consultations, no waiting lists and a ‘triple assessment’ screening process ensuring quick and accurate diagnosis.

Sponsored by

Read more at genesiscare.com HEALTHAWARENESS.CO.UK

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Breast reconstruction is changing; women need to know more WRITTEN BY: DAN MARSH Co-founder, Plastic Surgery Group and member of The British Association of Aesthetic Plastic Surgeons (BAAPS)

There remains national variation in how women with breast cancer are treated. Not all hospitals offer the full range of reconstructive options. For most women, finding out that they have breast cancer will be one of their hardest experiences, so what choices do they have after surgery?

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lastic surgeon, Dan Marsh, works at the Royal Free Hospital in London. It is here that he chairs an awareness group for women interested in breast reconstruction after cancer.

While billed as something of a ‘show and tell,’ it gives a safe space for women who are currently undergoing treatment or who are interested in exploring their options following breast cancer care.

“It’s been running for around five years,” Mr Marsh says: “I start off with a brief talk and then we introduce current patients to our previous patients, so that they can ask the questions they really want to know. We started off with a handful of women; now we’re up to 40-60 at these events – we’re going to need a bigger room!”

Breast cancer surgery: how it could save your breast

Outcomes are often more pleasing to women when a plastic surgeon works together with her breast surgeon.”

fter first diagnosis, various options await. The cancer is first tested via a biopsy to see what receptors it contains. These receptors attach to the hormones oestrogen and progesterone, which can fuel the grow th of cancer.

Clinicians also look for evidence of HER2, a gene that instructs cells to make protein that can spread rapidly.

It is among these fast-fueled cancers that patients are ver y much involved in their treatment plan, which could now become less invasive.

Dr Julie Doughty, President of the Association of Breast Surgery says: “Typically, once someone is diagnosed with breast cancer, the majority will have surgery as their first treatment. But for the 10-15% of those with the HER2 protein, or in the 30% of patients who do not have the oestrogen receptor, there is the option of receiving chemotherapy before surgery and this could benefit the patient in many ways.”

Breast reconstruction awareness groups are popular The groups are certainly popular and allow time for case histories and follow ups to various procedures. Questions such as: “What was the recovery really like?”; “When did you go back to work?” and: “What does it feel like?” are encouraged.

For many women, this group is their first step in understanding the options available to them, something that Mr Marsh says is compounded by what each individual NHS hospital is prepared to offer.

He says: “Depending on the type of surgery needed, there can be many options on the table, such as complete breast removal, a breast implant – either at the same time or delayed – and the possibility of using the patient’s own tissues to reconstruct the breast. Some women won’t even know that they are allowed a reconstruction - it all depends on the hospital.”

Symmetrisation surgery to the other breast post-surgery is coming under threat As NHS funding becomes stretched, important procedures such as operating on the other non-cancer breast to give a better size match to the operated-on cancer breast, are under threat.

While aesthetics are taken into account, the traditional way of treating breast cancer may not call for a plastic surgeon’s input at all, although outcomes seem to be more pleasing to women when a plastic surgeon works together with her breast surgeon.

Mr Marsh says: “Some women won’t even know about the full range of reconstructive choices available and they find it hard to talk through everything in the 20 minutes they have with their doctor.

These groups are a lifeline to patients who get the opportunity to ask what it really entails. I think all hospitals should have them.”

While Mr Marsh knows of a handful of hospitals in the NHS that have similar groups, he believes that they should be more widespread, and plans to open a further group for relatives shortly.

He says: “We know a lot more about what is safe following breast cancer. While implants are a simple option, there are other options using your own body tissues, which are only provided by a plastic surgeon, that change with them as their bodies grow older. It’s through these groups that we are Read more at spreading that message. I think every healthawareness.co.uk hospital should have one.”

6 HEALTHAWARENESS.CO.UK

When diagnosed with breast cancer the next steps can be scary, with many options available. That is why doctors are working harder than ever to make women aware of what paths they can choose.

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Treatment can radically reduce the tumour While chemotherapy is prescribed after surger y as standard, t he concept of switching the process to chemotherapy before surgery can radically reduce the tumour, depending on its initial size.

This is called neoadjuvant chemotherapy and it means that a planned mastectomy could instead turn into a smaller lumpectomy if the tumour is found to have shrunk.

Or, using oncoplastic techniques, there is the option of other procedures that allow a woman to avoid

INTERVIEW WITH:

DR JULIE DOUGHTY President, the Association of Breast Surgery mastectomy. The first procedure removes the tumour as part of a breast reduction. The surgeon performs the same procedure on the other breast to ensure they are the same size. This style of treatment depends on the size of tumour and the size of the woman’s breasts to make sure the best aesthetic result is achieved. Alternatively, skin and fat can be moved from the back and abdomen leaving the muscle, a local perforator flap. This is a much smaller procedure than a conventional breast reconstruction and is used to fi ll the defect after lumpectomy, leading to a much improved cosmetic result and avoiding mastectomy.

W it h c he m o t he r ap y t a k i n g between six to eight cycles, most clinicians will give women the choice of which way round they would prefer their treatment. For younger women, especially if there is a preference to save the breast, then the ability to shrink the tumour through chemotherapy gives a number of new options.

Hormone rich cancers could use a tablet for results If the cancer is hormone rich, this could indicate that the patient is less likely to receive chemotherapy and could use a tablet instead to shrink the tumour. Dr Doughty says: “In older women, who want to try and save their breast, one option is to give a hormone tablet to try and shrink the tumour prior to surgery. This approach, however, may take up to nine months before the tumour shrinks.

We want to think about the aesthetics of living after breast cancer but understand it is a big choice for a patient to make and they may need a number of appointments to make their decision in full.” It is this option of patient choice (which is so unusual for many), that doctors really want patients to understand.

For Dr Doughty, there are a number of questions that newly diagnosed patients should be asked, and they include: “Does the cancer have oestrogen? Does it have HER2 protein?

Is the patient suitable for a lumpectomy or mastectomy? If mastectomy is recommended, are there any options that can be offered if they want to try and keep their breast?

“Essentially, all options should now be available to patients, but we understand that this choice can be overwhelming. The one thing to remember is to always come back and talk to your doctor; you don’t have to make a decision at the first appointment.”

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ADVERTORIAL

Ensuring a continuum of care for breast cancer patients

Technological innovation can help make a breast cancer patient’s journey through the health system better — from initial concerns and confident diagnosis to treatment and aftercare.

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o-one in the 21st century should be diagnosed with stage 3 or stage 4 breast cancer, says Lori Fontaine, Global Vice President of Clinical Affairs for medical technology company, Hologic. “My goal is that all patients should be detected early when treatment is easier and survivability is 97% to 100%,” she says. “We know that if we can diagnose earlier, more lives can be saved. There's much more to do to get to that point, but it is an achievable goal.”

Over the last 20 years, milestone innovations in diagnosis and treatment have made early stage breast cancer a more survivable disease. Mammography screening programs introduced in many countries in the late 1980s and early 1990s have reduced mortality by 40%. Other technological advances include 3D breast imaging; RFID tags, which, once positioned within a lesion, are able to guide surgeons to smaller tumours with greater accuracy, and markers, which

provide 3D dimensional targeting for radiation therapy.

Clinical understanding across the patient pathway will make diagnosis and treatment even smarter Fontaine believes there has never been a more exciting time to be working in the area of breast health.

“I think we're going to see more technological innovations making cancer diagnosis and treatment even smarter,” she says.

“But this isn't just about doing one thing. It's about educating women, putting the right opportunity for screening in front of them, detecting the disease early, giving them the right treatments and the right follow-through.”

It 's also about making the breast health care continuum - the journey the patient takes from initial concerns and diagnosis to treatment and aftercare - as easy and qualitative as possible. I believe Hologic is uniquely positioned to help achieve

how we can facilitate the communication between the radiologist and the breast surgeon by providing breast lesion localisation with unique tag IDs.

INTERVIEW WITH:

LORI FONTAINE Global Vice President, Clinical Affairs, Hologic this by having clinical competence within mammography, biopsy solutions as well as surgical technology to support the targeting of challenging lesions.

An example is our intraoperative imaging solutions, which allow breast specimen images to be taken in the theatre and then sent digitally to the radiology department for verification instead of risking distortion of the specimen during transport. Or

‘Early detection is key for fast growing, aggressive breast cancers’

Laura’s mum was diagnosed with breast cancer, which she lived with for twenty-one years. Nearly four years after her mum’s death, Laura found a lump.

Artificial intelligence offers chance of personalised care Advances in artificial intelligence can also push boundaries, such as offering the possibility of personalised procedures. “We are learning so much more about the breast cancer risk for individual women,” explains Fontaine. “Let's say physicians have access to an amazing database of medical information featuring millions of women of every ethnicity around the globe. Then they could determine, for example, the best screening technology for each individual sitting in front of them.”

To make sure this area of women's health stays innovative, healthcare companies have to put themselves in the patients' shoes, says Fontaine. “They have to understand what patients are going through;

because if they don't listen to them, they won't learn. We have to think about how to do things differently and always put the patient first if we want to keep improving.

The future, the way we see it at Hologic, will be a more personalised pathway across the entire ecosystem from early detection to treatment that is simultaneously more compassionate for woman and more efficient for healthcare systems. We cannot rest until all patients are detected early, when treatment is easier and survivability for breast cancer is 97% to 100%.”

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WALK – RUN – BAKE – SELL - CYCLE - RECYCLE for breast cancer research

M

um's diagnosis made me breast aware and less shy about going to the GP with symptoms. In fact, I rang the doctors the day after first feeling the lump. Within weeks, I was diagnosed with a fast-growing stage 1 invasive ductal carcinoma.

After my lumpectomy, my husband and I started preventative IVF. We have a daughter, but we were hoping for a second child so we wanted a safeguard should the treatment impact my fertility.

The side-effects of chemotherapy are awful but, when I feel well, I make the most of it.

I go running, enjoy cooking dinner and have a glass of wine when I can as there are days when I'm bloated, achy and unable to stomach food.

People see me feeling okay, but I want people to know that it is not always like that and that’s okay too.

S o much ha s cha nge d si nce Mu m's treatment. While more people are being diagnosed, more are surviving thanks to research.

When discussing the best treatment plan for me, my consultant calculated my prognosis with treatment and without. The results were overwhelming.

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I have primary breast cancer and I'm lucky that I found it in time. If I had delayed, the rate at which it was growing, it could have spread.

That's why I'm a walking ambassador of early detection and I hope effective routine screenings are developed for younger women.

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Helping women live well with secondary breast cancer

Providing women living with secondary breast cancer the support they need today and funding vital research to stop breast cancer spreading and to treat it effectively when it does.

W

hile more people than ever are surviving breast cancer, there are around 35,000 people in the UK living with secondary breast cancer, which is incurable.

Secondary (or metastatic) breast cancer occurs when the cancer spreads from the breast to other parts of the body, most commonly to the bones, lungs, liver or brain.

While it cannot be cured, there are treatments that can control certain forms of the disease for some time and relieve symptoms to help people live well for as long as possible.

Support to help patients live well The uncertainty of living with an incurable disease can be one of the hardest parts, and a diagnosis of secondary breast cancer can affect every area of people’s lives, including

work, finances, family and their emotional and physical wellbeing.

With the right care and support, people can feel less alone and more confident in making decisions about complex treatment options, their lifestyle and their care.

This is why we run our Living w it h Secondar y Breast Cancer events, to enable women to talk openly with others living with the disease and to hear from expert speakers providing specialist information.

Bringing nurses together We also work with secondary breast cancer nurses across the UK to create a network of experts to share best practice and support them to deliver the best possible care.

We’ve developed a digital toolkit of practical guidance and resources to help nursing teams set up support

If we are to finally stop more women dying from breast cancer, we urgently need to develop new therapies to stop the disease spreading and to treat it effectively when it does.” ser v ices that help address the unique needs of people living with secondary breast cancer.

It’s really encouraging that many hospitals are already striving to improve their support services for secondary breast cancer patients, but it’s vital we all work together to reduce variation across the country and ensure everyone receives the highest standards of care.

Developments in research If we are to finally stop more women dying from breast cancer,

WRITTEN BY: CATHERINE PRIESTLEY Clinical Nurse Specialist, Breast Cancer Care and Breast Cancer Now

we urgently need to develop new t herapie s to s top t he d i s e a s e spreading and to treat it effectively when it does.

Professor Clare Isacke at the Breast Cancer Now Toby Robins Research Centre at The Institute of Cancer Research, London is investigating how breast cancer cells interact with their surroundings to enable them to spread around the body.

Ultimately, her team want to identify new targets for therapy, as well as find ways to prevent secondary breast cancer.

It’s currently incredibly challenging to treat breast cancer that has spread to the brain, as its security system stops many drugs reaching it.

So we’re also funding Professor Leonie Young’s research at the Royal College of Surgeons in Dublin, to understand whether drugs that block a protein called RET could help treat

secondary tumours in the brain.

Already, we’ve seen the introduction of a new generation of medicines called CDK 4/6 inhibitors to NHS treatment, which can help slow the spread of the disease for some patients and help them to continue with daily life. But we need to invest in research to develop new options for all sub-types of the disease.

With around 11,500 women and 80 men losing their lives to the disease each year in the UK, there is so much more to do on secondary breast cancer. We will continue to work tirelessly to reach our vision that, by 2050, everyone diagnosed with breast cancer will live and be supported to live well.

Read more at healthawareness.co.uk

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Genomic testing helps women to tailor their breast cancer care Genomic testing is available on the NHS and could be credited with saving thousands of women each year from chemotherapy they don’t need.

W

hile awareness rates of breast cancer are rising, t r e at m e nt p l a n s a r e starting to become more tailored.

For most women, this means developing a treatment pathway based on a sample of a tumour to determine the type and aggressiveness of the tumour, but this leaves a number of patients who perhaps don’t fall into a clear category.

Erring on the side of caution, chemot herapy is of ten recommended, and in some cases, it would be recommended needlessly.

The O nc ot y p e DX Bre a s t Recurrence Score® test, however, allows the underlying gene expression of each individual patient’s tumour to be analysed to more precisely determine aggressiveness and help guide more personalised treatment decisions.

Thousands fewer women needed chemo following the study Dr Sophie McGrath is a Consultant Medical Oncologist at the The Royal Marsden NHS Foundation Trust, and can now offer her patients a more personalised treatment pathway.

It comes after a large data set of genomic testing – known as the MEDIAPLANET

TAILORx study – was published. It found that the Oncotype DX® test, a genomic test available on the NHS, can precisely determine the value of chemotherapy and identify the patients who receive no benefit from it.

The study, published in 2018, a na lysed data f rom long-ter m follow-up of patients who received the test. TAILORx revealed that, for some types of cancer, thousands of women are likely to be able to avoid chemotherapy every year in the UK. That would lift a substantial burden off the NHS and make sure that women were not subjected to unnecessary overtreatment.

This has changed the way patient care is managed for Dr McGrath: “Patients who have genomic testing often feel that their treatment recommendations are more personalised. When it comes to cancer there is no ‘one-size-fits-all treatment’.”

In contrast, some women may be missing out on the chemotherapy treatment they need The study also pinpointed that some women were undertreated and missing out on chemotherapy.

Dr McGrath explains: “Just by looking at risk factors, such as

70% of patients initially recommended for chemotherapy dropped to just 27% after genomic testing.”

INTERVIEW WITH:

DR SOPHIE MCGRATH Consultant Medical Oncologist, Royal Marsden Hospital [tumour] size, grade and the age of the woman, a decision to proceed with hormones might be reached [without adding chemotherapy]. The study highlighted that for some of these women, their cancer was more aggressive than previously thought.

The numbers are small, but it is something for clinicians to keep in mind when recommending genomic testing.”

Earlier this year, Dr McGrath worked on another project called PONDx, which studied roughly 600 patients. It tested the initial treatment approach of the clinician (based on a standard patient evaluation), and then re-evaluated the treatment plan once a genomic test had been completed.

While 70% of the patients were initially recommended chemotherapy, this dropped dramatically to just 27% after testing. The team is currently analysing further data and hopes to present their findings early next year.

‘Predictive’ vs ‘prognostic’ testing – understanding the jargon For some patients, they may hear oncologists talk about predictive and prognostic tests, which can seem confusing. But Dr McGrath reveals a simple way to understand: “When you hear the word ‘predictive’, we are debating what the outcome of a therapy might be, such as whether the patient will gain a positive outcome from chemotherapy. When you hear ‘prognostic’, this is about the overall outcome and chance of recurrence, despite whatever therapies you encounter along the way.”

Other available genomic tests are

prognostic only and inform patients' risk of cancer relapse if treated without the addition of chemotherapy - not whether adding chemotherapy would be beneficial for the patient.

Oncotype DX is the only available test with proven predictive and prognostic capability, helping patients and clinicians precisely determine the likely benefit of adding chemotherapy to the treatment pathway.

The f ut u re of brea st c a ncer treatment is about gathering and analysing data, which will revolutionise the treatment of cancer throughout the patient journey.

WRITTEN BY: GINA CLARKE

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Read more at oncotypeiq.co.uk genomichealth.co.uk twitter.com/GenomicHealth

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14 years of unsuitable breast forms led to radical new design

© ANCHIY

Don’t let other people’s ways of tackling cancer make you feel inadequate.

Everyone fights it their own way.”

WRITTEN BY: SAMANTHA JACKMAN Director, Boost Innovations LTD

Hot, heavy and uncomfortable to wear – how one woman’s experiences prompted a design revolution in breast prosthesis products.

A

t 47 years old, Sue Jackman was fit, active and did not expect to be diagnosed with breast cancer.

Her mastectomy left her with scar tissue extending into the arm pit after the removal of the lymph nodes on her left side. After being issued with a silicone prosthesis, Sue was reluctant to wear it because it felt uncomfortable, hot and heavy.

Fourteen years after her surgery, Sue has been supporting daughter, Samantha, to develop a new type of breast prosthesis that redefi nes the breast form with radical shape, colour and design choices.

Choosing not to wear prosthesis “My mum has always been a little unconventional,” says Boost co-founder, Samantha Jackman. “So I wasn’t surprised that she rebelled against wearing her chicken-fillet-type breast form. What surprised me was her underlying reason for doing so, and the more I thought about it, the more I realised that there might be other women who felt the same way.”

Samantha’s mum didn’t find the breast form visually appealing or comfortable to wear. “She asked me why the hospital felt that she needed to replace the breast she had lost with a ‘lump of flesh’, and why people assumed everything needed to be skin tone, when nobody’s skin was the beige colour represented in the product,” Samantha says. "I remember clearly the day that mum jokingly threw the breast prosthesis at my friend, who caught it instinctively and then dropped it in horror. Standing in the kitchen with her head bald from her chemo, mum laughed at his reaction and we all ended up laughing together. It showed us how unappealing the design and texture could be if you had not seen one before."

"The assumptions that were being made about the design of the product were obvious.

“Mum wanted to wear a breast form sometimes, to help provide shape and contour under her clothing. What she didn’t want was a replacement breast, or a product that made her hot and sweaty. This meant that she often chose not to wear anything at all, and this had an effect on the clothing that she could wear comfortably. " Listening to real women to overcome design challenges After several years of trying different prosthesis types, none of which suited Sue’s lifestyle, daughter Samantha co-founded Boost, a company dedicated to making a change by listening to the voices of women and acting on their suggestions to create new product ideas.

Like Samantha’s mum, many were dissatisfied with their breast prosthesis, saying that

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it was hot, heavy and sweaty, which makes it uncomfortable to wear. "With the ‘chicken fi llet’ style breast prosthesis only available in beige, slightly darker beige or yellowish beige, we just didn’t think that was acceptable; it’s a poor imitation of skin colour. We wanted to design a product that reflected women's choice, style and personality with a range of colours that create a desirable and aesthetically pleasing product," Samantha says.

Standard breast forms are a hassle in everyday life The current breast form design is also packaging-heavy, encased in plastic to retain its shape. It also has a short product life due to the delicate film that encases the gel. It is at risk of leaking or rupture, needs cleaning with gentle care and cannot be worn in the swimming pool or sea.

"The prototype breast form that I've been wearing has been much better than the conventional styles," Sue explains. " I don't feel worried that it might get damaged or leak.

I remember the first time that I tried the prototype and it felt great, but it was also pretty and colourful. I had actually found something that I was pleased to wear."

Having been advising on the process since the beginning, Samantha's mum was an obvious choice to join in with the testing groups.

"The colours fit in with your outfit and style, and the structure allows air to circulate. It's been great for swimming and is really easy to clean too. Plus, I don't get as hot and sweaty anymore." she says.

Made in Cornwall As a small business, Boost has had some challenges in designing and creating their reimagined breast form, but the feedback from women has kept Samantha motivated.

"Women have told us that our new design is making a difference to them, and is a great alternative choice particularly for those who dance, swim and are active," she says.

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How MasterChef winner, Jane, tackled breast cancer For MasterChef winner, Jane Devonshire, fast action and the kitchen table were crucial to tackling breast cancer.

O

n l y i n t he f i n a l e pi s o de Ja ne Devonshire won MasterChef in 2016 did she reveal that she had had breast cancer. "I didn't want to win because of the cancer. It was liberating to win because of my cooking. My illness was irrelevant," says the stay-at-home mother of four.

Aged 41, Jane found a lump. She did not smoke, was not overweight, walked daily and had no family history of cancer, but went to her GP quickly. A lumpectomy, radiotherapy and chemotherapy followed.

Jane says: "Don't let other people's ways of tackling cancer make you feel inadequate.

Everyone fights it their own way."

For Jane, the kitchen played a big part.

"Even when I couldn't eat, I cooked the family dinner. It may only have been shepherd's pie or sausage and chips, but sitting down to eat with the children and talking about school, and what was going on with me, maintained our normality."

Almost five years after the all-clear, a scan revealed a secondary breast cancer in her liver.

"It was the darkest time, but, seven years later, I am still in remission, and feeling lucky and grateful to everyone who helped."

Jane advises: "Attend all your mammogram and smear appointments. Check your breasts and, if you find anything unusual, consult your GP quickly.

INTERVIEW WITH:

JANE DEVONSHIRE Winner of MasterChef 2016 "I have heard of women delaying for six months. That time can be critical. Don't put it off because you are frightened or busy or fear you may be overreacting, and don't beat yourself up about how you should have led a healthier life. "Just go to your doctor."

WRITTEN BY: LINDA WHITNEY

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healthawareness.co.uk Get in touch for the next edition maggie.platten@mediaplanet.com uk.info@mediaplanet.com @mediaplanetUK

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