National Audit of Breast Cancer in Older Patients: 2018 Annual Report

HQIP | June 2018 | National Audit of Breast Cancer in Older Patients: 2018 Annual Report

Health Quality Improvement Programme (HQIP) has  produced a report which presents information on the care received by women diagnosed between 1 January 2014 and 31 December 2016 in England and Wales. As well as describing how these patterns of care differ between women in the younger and older age groups, the report also distinguishes between three main groups of breast cancer – women with ductal carcinoma in situ, with early invasive disease , and with advanced disease.

HQIP
Image source: hqip.org.uk

The report is primarily written for clinicians, providers of breast cancer services, commissioners and healthcare regulators. A version for patients and the general public will be available in summer 2018 (Source: HQIP).

Further details are available from HQIP 

The report can be read in full here 

6 in 7 women offered Tamoxifen choose not to take it

University of Leeds | April 2018 |Women at increased cancer risk shun preventative tamoxifen therapy

A study published in Breast Cancer Research and Treatment  shows that only 1 in 7 women who were offered Tamoxifen due to a familial history of cancer decided to take it. This new research sought to highlight that women eligible to take the drug were electing not to, it also aimed to explore the reasons behind such decisions. Researchers also found that patients consulted informal networks such as friends and family before making a decision about whether to take Tamoxifen (via University of Leeds) .

Whether the participants had children also had an impact on the decision, the scientists found those with children were more likely to take the drug. One participant explained that taking the drug might affect her ability to care for her children and parents, so decided not to take it.

The study was conducted in collaboration with scientists at the University Hospitals Southampton, University College London, Queen Mary University, University of Leeds and Northwestern University. The research was funded by Cancer Research UK and Yorkshire Cancer Research.

 

Abstract

Purpose Uptake of preventive therapy for women at increased breast cancer risk in England is unknown following the introduction of UK clinical guidelines in 2013. Preventive therapy could create socioeconomic inequalities in cancer incidence if it is more readily accepted by particular socio-demographic groups. In this multicentre study, we investigated uptake of tamoxifen and evaluated socio-demographic and clinical factors associated with initiation. We explored women’s experiences of treatment decision-making using qualitative interview data.
Methods Between September 2015 and December 2016, women (n=732) attending an appointment at one of 20 centres in England to discuss breast cancer risk were approached to complete a survey containing socio-demographic details and nul-
liparity. Of the baseline survey respondents (n equal to 408/732, 55.7% response rate), self-reported uptake of tamoxifen at 3-month follow-up was reported in 258 (63.2%). Sixteen women participated in semi-structured interviews.
Results One in seven (38/258=14.7%) women initiated tamoxifen. Women who had children were more likely to report use of tamoxifen than those without children (OR=5.26; 95%CI: 1.13–24.49, p=0.035). Interview data suggested that women weigh up risks and benefits of tamoxifen within the context of familial commitments, with exposure to significant other’s beliefs and experiences of cancer and medication a basis for their decision.

Conclusions Uptake of tamoxifen is low in clinical practice. There were no socio-demographic differences in uptake, suggesting that the introduction of breast cancer preventive therapy is unlikely to create socioeconomic inequalities in cancer incidence. Women’s decision-making was influenced by familial priorities, particularly having children.

The full article can be downloaded here 

All-Party Parliamentary Group (APPG)report on breast cancer finds inequalities in diagnosis, treatment and care based on where you live

All-Party Parliamentary Group on Breast Cancer | A Mixed Picture: An Inquiry into Geographical Inequalities and Breast Cancer | 2018

A Mixed Picture: An Inquiry into Geographical Inequalities and Breast Cancer has found that people in England are experiencing differences in their diagnosis, care and treatment due to their location rather than their clinical need. In response to this the APPG ran an inquiry from October 2016 to November 2017 to discover where and why inequalities arise and what the possible solutions might be.

 

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Image source: breastcancernow.org

Evidence presented to the inquiry showed some innovative and high performing services, but  unacceptable differences exist at every level of geography. Some regions of the country perform better in certain areas of care or treatment than others. Stark differences in the availability of services can also occur within very local geographies, from town to town or even within individual towns and cities.

This report outlines key recommendations to address these disparities, the authors call on NHS England and Public Health to address these inequalities through better workforce planning and data collection; as well as calling for  improving the consistency, transparency and accountability of commissioning and delivery of cancer services through new NHS improvement and structures.

The report can be read here 

 

New way to target the growth of breast cancer cells

Researchers have found a new way of halting the growth of breast cancer cells. They hope that their discoveries can be further developed into a new way of treating breast cancer, and possibly other types of cancer. | Nature Communications | via ScienceDaily

An international team of researchers led from Karolinska Institutet and Science for Life Laboratory in Sweden have found a new way of halting the growth of breast cancer cells. In their study, which is published in Nature Communications, the researchers explore a new way to starve cancer cells from their molecular energy source.

In the study, the researchers confirmed that hormone-driven breast cancer cells use a newly discovered protein, NUDT5, to produce energy in the cell nucleus. This nuclear energy source provides energy for the expression of genes that drive cancer growth.

In the next stage of their research, they developed a molecule able to block NUDT5 activity and thus deprive the cancer cells of their means of nuclear energy production. They demonstrated that this new molecule can stop the growth of breast cancer cells in isolated laboratory experiments.

Full detail at ScienceDaily

Full reference: Page, B et al. | Targeted NUDT5 inhibitors block hormone signaling in breast cancer cells | Nature Communications |  2018; 9 (1)

 

NICE approves breakthrough breast cancer drugs

NICE confirms that it will recommend that breakthrough cancer drugs palbociclib and ribociclib be provided on the NHS for women with advanced breast cancer| story via OnMedica

There are around 45,000 new diagnosis of breast cancer each year in England and it is estimated that around 8,000 of these people would be eligible for treatment with either palbociclib or ribociclib.

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In draft guidance, NICE said breast cancer patients should have routine access to these two life extending drugs after a new deal with their manufacturing companies who agreed to lower the price and who gave more evidence for their effectiveness.

Palbociclib (Ibrance) from Pfizer and ribociclib (Kisqali) from Norvatis, are recommended for people with hormone receptor (HR) positive, HER2 negative locally advanced or secondary breast cancer.

NICE said that although there were some uncertainties on how long they extend the life expectancy of people with this type of breast cancer, these promising new drugs were found to stall the growth of cancer for an extra 10 months on average.

Breast cancer can return 20 years after treatment

Risk of certain breast cancers coming back remains for at least 20 years after treatment | New England Journal of Medicine | Story via Cancer Research UK

Research, carried out by The Early Breast Cancer Trialists’ Collaborative Group collected data from more than 60,000 women who had been diagnosed with hormone sensitive breast cancer (usually called oestrogen receptor positive or ER+ breast cancer) between 1976 and 2011.

All of the patients were given a type of anti-oestrogen therapy for five years as part of their treatment. At the five year mark the women had no signs that their breast cancer had come back and treatment ended.

The figures, published in the New England Journal of Medicine show that out of the women included in the study, 11,000 had their cancer come back in another part of the body such as the bone, liver and lung in the 15 years after stopping treatment. They also showed that the risk of cancer coming back remained the same year on year from when they stopped taking the anti-oestrogen drugs to 15 years later.

Full story at Cancer Research UK

Full reference: Pan, H. et al. (2017) 20-Year Risks of Breast-Cancer Recurrence after Stopping Endocrine Therapy at 5 YearsNew England Journal of Medicine.

 

Radiation risk with digital mammography in breast screening

This review estimates the risks and benefits of breast screening in terms of deaths due to radiation-induced cancers and lives saved by digital mammography in the NHS Breast Screening Programme in England.

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A radiation risk model, patient dose data and data from national screening statistics were used to estimate the number of deaths due to radiation induced breast cancers in the NHSBSP in England. The breast cancer mortality reduction in the invited population due to screening, and the percentage of women diagnosed with symptomatic breast cancer who die from that cancer, were collated from the literature. The number of lives saved due to screening was calculated.

The main findings are that:

  • the risk of a radiation-induced cancer for a woman attending full field digital mammographic screening (2 views) by the NHSBSP is between 1 in 49,000 to 1 in 98,000 per visit
  • if a woman attends all 7 screening examinations between the ages of 50 to 70, the risk of a radiation-induced cancer is between 1 in 7,000 to 1 in 14,000
  • it is estimated that about 400 to 800 cancers are detected by the NHSBSP for every cancer induced
  • the mortality benefit of screening exceeds the radiation-induced detriment by about 150:1 to 300:1
  • for the small proportion of women with breasts thicker than 90mm who receive higher radiation doses, the benefit will exceed the risk by about 100:1 to 200:1

Full report at Public Health England