Immune cells key to predicting cancer outcomes

University of Edinburgh | April 2019 | Immune cells key to predicting cancer outcomes

Research that focused on the  role of immune cells in endometrium – the womb lining – and breast cancers has identified a set of genes that are expressed at high levels in breast cancer tumours and linked to more aggressive cancer types.

Immune cells normally help the body stay healthy by warding off pathogens such as viruses and bacteria. However, sometimes immune cells can wrongly identify cancer tissue as healthy tissue, aiding the spread of tumours.  Until this research how these cells behave in human cancer was little known, making them difficult to spot and target.

The researchers also identified 37 genes that were highly expressed in breast cancer tumour immune cells – known as tumour-associated macrophages (TAMs) – compared with healthy tissue.

This genetic signature is particularly strong in aggressive cancers, including triple negative breast cancer, which is notoriously difficult to treat.

The experts behind the study suggest that their findings could be used to offer clues to diagnosis and predicting patient survival and reveal significant insights into how tumours behave in common cancers (Source:University of Edinburgh).

Read the full story at University of Edinburgh 

The article is available to read from Cancer Cell 

Independent Breast Screening Review: government response

Department of Health and Social Care | March 2019| Independent Breast Screening Review: government response
The Department of  Health and Social Care have published the government’s response to recommendations made by the Independent Breast Screening Review.

The Independent Breast Screening Review looked into an incident in the breast screening programme in England, which resulted in thousands of women aged between 68 and 71 not being invited to their final breast screening. The review published its report in December 2018.

This document sets out the government’s response to each recommendation made in the report. The government has accepted all the recommendations.

Full details from the Department of Health and Social Care

Annals of Oncology article: European cancer mortality predictions for the year 2019 with focus on breast cancer; “pancreas and lung cancer still show unfavourable trends”

M Malvezzi, M. et al | 2019| European cancer mortality predictions for the year 2019 with focus on breast cancer| Annals of Oncology| mdz051|  https://doi.org/10.1093/annonc/mdz051

A new piece of research that used cancer death certifications and population data from the World Health Organization and Eurostat databases estimated that there would be a reduction in cancer rates between 2014 and 2019, anticipating that this would be a reduction in male cancer rates (6 per cent) and females (4 per cent). The findings have now been published in the journal Annals of Oncology.

Introduction

Abstract

Background

To overcome the lag with which cancer statistics become available, we predicted numbers of deaths and rates from all cancers and selected cancer sites for 2019 in the European Union (EU).

 

Materials and methods

We retrieved cancer death certifications and population data from the World Health Organization and Eurostat databases for 1970–2014. We obtained estimates for 2019 with a linear regression on number of deaths over the most recent trend period identified by a logarithmic Poisson joinpoint regression model. We calculated the number of avoided deaths over the period 1989–2019.

 

Results

We estimated about 1 410 000 cancer deaths in the EU for 2019, corresponding to age-standardized rates of 130.9/100 000 men (−5.9% since 2014) and 82.9 women (−3.6%). Lung cancer trends in women are predicted to increase 4.4% between 2014 and 2019, reaching a rate of 14.8. The projected rate for breast cancer was 13.4. Favourable trends for major neoplasms are predicted to continue, except for pancreatic cancer. Trends in breast cancer mortality were favourable in all six countries considered, except Poland. The falls were largest in women 50–69 (−16.4%), i.e. the age group covered by screening, but also seen at age 20–49 (−13.8%), while more modest at age 70–79 (−6.1%). As compared to the peak rate in 1988, over 5 million cancer deaths have been avoided in the EU over the 1989–2019 period. Of these, 440 000 were breast cancer deaths.

 

Conclusion

Between 2014 and 2019, cancer mortality will continue to fall in both sexes. Breast cancer rates will fall steadily, with about 35% decline in rates over the last three decades. This is likely due to reduced hormone replacement therapy use, improvements in screening, early diagnosis and treatment. Due to population ageing, however, the number of breast cancer deaths is not declining.

See also:

OnMedica UK has fastest falling breast cancer rates in Europe

The full article is available from Annals of Oncology 

NICE draft guidance recommends pertuzumab for new breast cancer indication after improved price offer from company

NICE | February 2019 | NICE draft guidance recommends pertuzumab for new breast cancer indication after improved price offer from company

NICE has published final draft guidance recommending pertuzumab (Perjeta, Roche) for treating early HER2-positive breast cancer in people whose disease has spread to their lymph nodes.

This positive recommendation is for people who have had surgery for their breast cancer and whose cancer has already spread to their lymph nodes. The estimated 2700 people in this subgroup have a higher risk of their cancer returning.

The evidence shows that adding pertuzumab to trastuzumab and chemotherapy after surgery increased the proportion of people whose disease didn’t spread. However, there is a lack of evidence on how long, if at all, adding pertuzumab might increase the overall length of time people live.

Final guidance is expected to be published in March (Source: NICE).

The full details are available from NICE 

New trial suggests that younger women could benefit from annual screening

Breast Cancer Now | February 2019| New trial suggests that younger women could benefit from annual screening

A leading charity has funded research that found evidence that indicates women aged 35-39 at a moderate or high risk of developing breast cancer, could benefit from annual screening.

Professor Gareth Evans, who led the trial funded by Breast Cancer Now, looked at whether screening these women through annual mammograms could pick up tumours earlier. The study found that when tumours were picked up through screening, most were smaller in size, and were less likely to have spread to lymph nodes, compared to women who weren’t screened.

In total 2,899 women aged 35-39 at moderate or high risk of breast cancer due to their family history were offered annual screening across 34 UK centres between 2006 and 2015.

mammography-2416942_640.jpg

In total, 50 breast cancers were detected (in 49 women), of which 35 were invasive tumours. Of the 35 invasive breast cancers, 80% (28/35) were detected by screening when the tumour was 2cm or smaller in size, and only 20% (7/35) had spread to the patients’ lymph nodes.

While the researchers acknowledge that further research to fully understand the risks and benefits of screening this group. However, detecting breast cancer early gives women the best possible chance of survival, and we would like the upcoming review of NHS cancer screening to consider these results and to review services offered to women with a family history of breast cancer.

Breast Cancer Now today called for the upcoming review of NHS cancer screening programmes to include an assessment of family history services across the country, and to set out the health economic evidence required to consider extending screening to women aged 35-39 at moderate or high risk due to their family history (Source: Breast Cancer Now).

Breast Cancer Now Annual screening detects breast cancers earlier for women aged 35-39 with a family history, major UK trial finds

See also:

University of Manchester Annual screening detects breast cancers earlier for women aged 35-39 with a family history

In the news:

BBC News Breast cancer: Scan younger women at risk, charity says

Use genetic data to predict the best time of day to give radiotherapy to breast cancer patients, say researchers

University of Leicester | November 2018 | Use genetic data to predict the best time of day to give radiotherapy to breast cancer patients, say Researchers

Scientists from the University of Leicester followed two independent cohorts of patients with breast cancer being treated with radiotherapy (P equal to 879); where the researchers found that patients with variations of two genes were more likely to experience side effects if they received radiotherapy in the morning. 

The researchers explain that this is due to their circadian rhythms, with radiotherapy treatment in the morning causing worse acute toxicity for these patients.  They suggest that in future treatment it may be possible to reduce toxicity associated with breast cancer radiotherapy by identifying gene variants that affect circadian rhythm and tailoring treatment for appropriate morning or afternoon radiotherapy.

Professor Paul Symonds, a consultant oncologist at Leicester’s Hospitals and professor of clinical oncology at the University of Leicester said: “Our study found that some patients with a particular genetic profile are more at risk of side effects if given radiotherapy in the morning. This happens because the skin of these particular patients divides earlier in the day than others and dividing cells are more easily damaged by X-rays. This could allow an easy way to personalise treatment just by recommending what time of day a patient should be treated.”

The study was part-funded by the Breast Cancer Now charity and supported by funding from the European Union Seventh Framework Programme for research, technological development and demonstration (Source: University of Leicester).

Read the full article from the University of Leicester

Read and download the article Genetic Variants Predict Optimal Timing of Radiotherapy to Reduce Side-effects in Breast Cancer Patients from Clinical Oncology

Johnson, K., Chang-Claude, J., Critchley, A. M., Kyriacou, C., Lavers, S., Rattay, T., … & Talbot, C. J. (2018). Genetic variants predict optimal timing of radiotherapy to reduce side-effects in breast cancer patients. Clinical Oncology. https://doi.org/10.1016/j.clon.2018.10.001

Abstract

Aims

Radiotherapy is an important treatment for many types of cancer, but a minority of patients suffer long-term side-effects of treatment. Multiple lines of evidence suggest a role for circadian rhythm in the development of radiotherapy late side-effects.

Materials and methods

We carried out a study to examine the effect of radiotherapy timing in two breast cancer patient cohorts. The retrospective LeND cohort comprised 535 patients scored for late effects using the Late Effects of Normal Tissue-Subjective Objective Management Analytical (LENT-SOMA) scale. Acute effects were assessed prospectively in 343 patients from the REQUITE study using the CTCAE v4 scales. Genotyping was carried out for candidate circadian rhythm variants.


Results

In the LeND cohort, patients who had radiotherapy in the morning had a significantly increased incidence of late toxicity in univariate (P equal to 0.03) and multivariate analysis (P equal to 0.01). Acute effects in the REQUITE group were also significantly increased in univariate analysis after morning treatment (P equal to 0.03) but not on multivariate analysis.

Conclusion

Our results suggest that it may be possible to reduce toxicity associated with breast cancer radiotherapy by identifying gene variants that affect circadian rhythm and scheduling for appropriate morning or afternoon radiotherapy.

In the news:

The Telegraph Radiotherapy should be given at different times of day to reduce side effects, Leicester Uni study suggests

Breast Cancer Care launches Alexa tool to help women spot key signs

Breast Cancer Care (BCC) has launched a virtual tool on Amazon’s Alexa which shares information on the signs and symptoms of breast cancer | via Digital Health

The tool can help guide women through a breast check and highlight the eight most common signs and symptoms of breast cancer to look out for.

Addie Mitchell, clinical nurse specialist at BCC, told Digital Health News that she hoped the digital tool would help give women more confidence to check for breast cancer. She said: “It gives them the confidence and assurance of being able to check in their own home. Checking for symptoms of breast cancer can cause a lot of anxiety as they don’t know what to look for, but the Alexa tool can help by listing the eight common ones.”

Mitchell added that the Alexa tool will also prompt users who may think they have one or more of the symptoms to get it checked out by their GP.

Full story at Digital Health