Record numbers beating breast cancer in the UK

More than 130,000 UK breast cancer deaths have been avoided in the last 30 years, according to new Cancer Research UK analysis to mark breast cancer awareness month

Breast cancer deaths in the UK hit a record high in 1989, when around 15,600 women lost their lives to the disease – but thanks to research developing new tests and better treatments, the death rate for women has since fallen by 44%.

This considerable drop is due to major advances in diagnosis and treatment. In the last three decades, we have seen improvements in surgical techniques and use of radiotherapy, new drugs being made available, and the impact of the national breast screening programme.

Full story at Cancer Research UK

See also: Breast cancer deaths almost halved since 1989, UK figures show | The Guardian

Breast cancer: Call for genetic screening for all

Study, published in JAMA Oncology looked at data on 11,800 women diagnosed with breast cancer in the UK, US and Australia, with findings suggesting that breast cancer genetic screening would save hundreds of lives each year | story via BBC News

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Offering every woman diagnosed with breast cancer genetic screening would save hundreds of lives each year, according to a new study published in JAMA Oncology.  Currently, only those with risk factors such as a close family history of breast cancer are offered the check. The analysis suggests one year’s testing could save 2,102 cases of breast and ovarian cancer and 633 lives in the UK.

The research says screening everyone would enable women to make informed treatment choices and allow family members to take preventative action. It would also be cost-effective for the NHS, they say.

Full story at BBC News

Full research paper: Sun L, Brentnall A, Patel S, et al. | A Cost-effectiveness Analysis of Multigene Testing for All Patients With Breast Cancer |  JAMA Oncology | Published online October 03, 2019

BMJ: Cancer screening uptake- only a third of women take up offers

Torjesen, I. | 2019| Cancer screening: only a third of women in England take up all offers | BMJ| 366 | l5588 | doi: https://doi.org/10.1136/bmj.l5588

A new study published in the BMJ indicates that of the screening services offered to women in their 60s, which include cervical, breast and bowel screening only a third attend these screening sessions.  

The study included over 3000 women aged between 60-65 who had responded to their last invitations from each of these three screening programmes.

Results showed that:

  • 35% took part in all three screening programmes;
  • 37% participated in two programmes;
  • 17% accessed one type of screening; and
  • 10% were not screened at all.

They found that in the last screening round, 2525 (83%) had taken up mammography, 1908 (62%) cervical screening, and 1635 (53%) bowel cancer screening, which is consistent with the proportions reported in the official statistics for England (78%, 58-59%, and 57-59%, respectively).

The researchers also explored area level correlations between participation in the three screening programmes and various population characteristics for all English general practices with complete data in the Fingertips database curated by Public Health England. This database reports health related data for England aggregated by administrative area.

General practices with higher proportions of unemployed patients and smokers had a lower rate of take-up of all three screening programmes. Conversely, general practices from areas with less deprivation, with more patients who are carers or have chronic illnesses themselves, and with more patients satisfied with the provided service were significantly more likely to attain high coverage rates in all programmes (Source:  Torjesen, 2019).

To determine how many women participate in all three recommended cancer screening programmes (breast, cervical, and bowel). During their early 60s, English women receive an invitation from all the three programmes.

For 3060 women aged 60–65 included in an England-wide breast screening case–control study, we investigated the number of screening programmes they participated in during the last invitation round. Additionally, using the Fingertips database curated by Public Health England, we explored area-level correlations between participation in the three cancer screening programmes and various population characteristics for all 7014 English general practices with complete data.
Results

Of the 3060 women, 1086 (35%) participated in all three programmes, 1142 (37%) in two, 526 (17%) in one, and 306 (10%) in none. Participation in all three did not appear to be a random event (p  less than 0.001). General practices from areas with less deprivation, with more patients who are carers or have chronic illnesses themselves, and with more patients satisfied with the provided service were significantly more likely to attain high coverage rates in all programmes.

Only a minority of English women is concurrently protected through all recommended cancer screening programmes. Future studies should consider why most women participate in some but not all recommended screening.

 

See also: King’s College London Only a third of women take up all offered cancer screenings, new research finds

BMJ Cancer screening: only a third of women in England take up all offers

[NICE Appraisal consultation] Approval for treatment option for early breast cancer after adjuvant trastuzumab [ID981]

NICE | August 2019| Approval for treatment option for early breast cancer after adjuvant trastuzumab [ID981]

Today (7 August 2019) The National Institute for Health and Care Excellence (NICE) has published draft guidance recommending neratinib as an additional treatment for some people with early hormone- receptor-positive human epidermal growth factor receptor 2 (HER2)- positive breast cancer. 

In a press release, NICE recommends Neratinib (also called Nerlynx and marketed by Pierre Fabre), under the terms of a commercial arrangement, for people with this type of breast cancer who are less than 1 year from completing trastuzumab (Herceptin)-based treatment following surgery (called adjuvant treatment).

The clinical trial evidence showed that people who had treatment with neratinib have less risk of disease recurrence than people who had treatment with a placebo. Despite there being no available data about how this might translate into increasing the overall length of time people live, the committee concluded that the cost-effectiveness estimates for neratinib made it an acceptable use of NHS resources.

Meindert Boysen, director of the Centre for Health Technology Evaluation at NICE, said: “Breast cancer remains the most common form of cancer in the UK, accounting for around 30% of all cancers in women. And although there have been advances in the treatment of early stage HER2-positive breast cancer, around a quarter of people treated with trastuzumab following surgery will have a recurrence of their cancer.

“We are therefore pleased to be able to recommend neratinib as a further treatment option for people with this type of breast cancer, based on the benefits it provides in extending the time before the disease gets worse and on its important potential to reduce the risk of the cancer returning.”

Neratinib, which is taken as 6 x 40 mg tablets daily for 1 year, is recommended provided trastuzumab is the only HER2-directed adjuvant treatment people have had (Source: NICE).

The guidance is in development, comments can be made via the  Appraisal consultation

The closing date for comments is Wednesday 28 August 2019

Related:

NICE [press release] NICE recommends additional treatment option for people with early breast cancer   NICE

See also:

OnMedica Approval for treatment option for early breast cancer 

 

 

Breast cancer drugs option joins cancer drugs fund

A potentially life-extending drug combination for some people with advanced breast cancer will now be available under the cancer drugs fund (CDF) following approval by NICE and publication of draft guidance

The draft guidance recommends ribociclib (also called Kisqali and made by Novartis) used with fulvestrant as an option for people with hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative, locally advanced or metastatic breast cancer who have had previous endocrine therapy.

The positive recommendation follows an improved patient access scheme by the company as part of a commercial arrangement.

Clinical trial evidence suggests that, compared with fulvestrant alone, ribociclib with fulvestrant increases the length of time before the disease progresses. However, it is not known whether ribociclib increases the length of time people live, because the final trial results are not available yet.

The committee recognised that ribociclib with fulvestrant has the potential to be cost-effective, and therefore recommended it for use on the CDF. This will allow more evidence to be collected to address the uncertainties around overall survival and cost-effectiveness.

Full dtail at NICE

The acceptability of addressing alcohol consumption as a modifiable risk factor for breast cancer: a mixed method study within breast screening services and symptomatic breast clinics

Sinclair JMcCann MSheldon E, et al | 2019| The acceptability of addressing alcohol consumption as a modifiable risk factor for breast cancer: a mixed method study within breast screening services and symptomatic breast clinics| 
New research now published in the BMJ Open, recruited women attending NHS Breast Screening Programme (NHSBSP) mammograms, symptomatic breast clinics and healthcare professionals in these settings, the study used a mixed-methods approach- interviews and surveys- to ask women about their knowledge and attitudes towards alcohol as a risk factor for breast cancer.
The findings highlight that only 20 per cent of women in the sample recognised alcohol as a breast cancer risk factor, almost half of NHS staff identified it as a risk factor. 
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Objectives Potentially modifiable risk factors account for approximately 23% of breast cancers, with obesity and alcohol being the two greatest. Breast screening and symptomatic clinical attendances provide opportunities (‘teachable moments’) to link health promotion and breast cancer-prevention advice within established clinical pathways. This study explored knowledge and attitudes towards alcohol as a risk factor for breast cancer, and potential challenges inherent in incorporating advice about alcohol health risks into breast clinics and screening appointments.

Design A mixed-method study including a survey on risk factors for breast cancer and understanding of alcohol content. Survey results were explored in a series of five focus groups with women and eight semi-structured interviews with health professionals.

Setting Women attending NHS Breast Screening Programme (NHSBSP) mammograms, symptomatic breast clinics and healthcare professionals in those settings.

Participants 205 women were recruited (102 NHSBSP attenders and 103 symptomatic breast clinic attenders) and 33 NHS Staff.

Results Alcohol was identified as a breast cancer risk factor by 40/205 (19.5%) of attenders and 16/33 (48.5%) of staff. Overall 66.5% of attenders drank alcohol, and 56.6% could not estimate correctly the alcohol content of any of four commonly consumed alcoholic drinks. All women agreed that including a prevention-focussed intervention would not reduce the likelihood of their attendance at screening mammograms or breast clinics. Qualitative data highlighted concerns in both women and staff of how to talk about alcohol and risk factors for breast cancer in a non-stigmatising way, as well as ambivalence from specialist staff as to their role in health promotion.

Conclusions Levels of alcohol health literacy and numeracy were low. Adding prevention interventions to screening and/or symptomatic clinics appears acceptable to attendees, highlighting the potential for using these opportunities as ‘teachable moments’. However, there are substantial cultural and systemic challenges to overcome if this is to be implemented successfully.

Read the article in full from the BMJ Open

In the news:

BBC News Women not aware enough of breast cancer link to alcohol

Societal impact of treatment of early breast cancer

RAND Europe has the findings from a study on the societal impact of early breast cancer.  The findings are published in the following reports: