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:

Night shift work and risk of breast cancer in women

Jones, M.E. et al. | 2019|Night shift work and risk of breast cancer in women: the Generations Study cohort | British Journal of Cancer |https://www.nature.com/articles/s41416-019-0485-7

Scientists have examined risk of breast cancer in relation to timing of night shift work and receptor status, in a large UK cohort study- The Generations Study (GS)- of more than 113,700 females aged 16 or over from the United Kingdom. Breast and other cancers occurring in the cohort were identified from recruitment and follow-up questionnaires, and spontaneous reports to the study centre. Their detailed analysis found no evidence for an overall increase in risk of breast cancer for women who had been night shift workers within the last 10 years, or by hours worked per night, nights worked per week, average
hours worked per week, cumulative years of employment, cumulative hours, or time since cessation of such work. With the research found no significantly raised risks with type of night shift occupation (Source: Jones et al, 2019)

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Background: It is plausible that night shift work could affect breast cancer risk, possibly by melatonin suppression or circadian clock disruption, but epidemiological evidence is inconclusive.
Methods: Using serial questionnaires from the Generations Study cohort, we estimated hazard ratios (HR) and 95% confidence intervals (95% CI) for breast cancer in relation to being a night shift worker within the last 10 years, adjusted for potential confounders.
Results: Among 102,869 women recruited in 2003–2014, median follow-up 9.5 years, 2059 developed invasive breast cancer. The HR in relation to night shift work was 1.00 (95%CI: 0.86–1.15). There was a significant trend with average hours of night work per week (P = 0.035), but no significantly raised risks for hours worked per night, nights worked per week, average hours worked per week, cumulative years of employment, cumulative hours, time since cessation, type of occupation, age starting night shift work, or age starting in relation to first pregnancy.
Conclusions: The lack of overall association, and no association with all but one measure of dose, duration, and intensity in our data, does not support an increased risk of breast cancer from night shift work in women.

The full article is available to read in full from British Journal of Cancer

In the news:

The Independent | May 2019 | Night shift work does not increase breast cancer risk, study suggests 

University of Nottingham Study: Drugs for invasive breast cancer ‘could treat earliest stages of the disease’

University of Nottingham | May 2019 | Drugs for invasive breast cancer ‘could treat earliest stages of the disease’

Experts from the University of Nottingham’s School of Medicine have undertaken research that has found drugs used to target HER2-positive invasive breast cancer may also be successful in treating women in the first stages of the disease.

The HER2 gene is already closely associated with aggressive, invasive breast cancer and is already treated using the drug trastuzumab, more commonly known as Herceptin.

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The Nottingham study looked at breast tissue from 776 women treated at Nottingham City Hospital between 1990 and 2012 for DCIS. It also collected information from 239 cases of DCIS and invasive breast cancer for comparison.

Following up on cases between two months and 20 years later, the team found that out of 308 patients treated with breast conserving surgery alone, the disease had reoccurred in 67 people (22 per cent). More than half of those (57 per cent) had gone on to develop aggressive, invasive breast cancer. Among the 93 cases treated with surgery and radiotherapy, the cancer came back in eight patients – two with invasive breast cancer and six with DCIS.

The researchers suggest that screening women with DCIS for HER2 may help to identify those at greater risk of developing more invasive forms of the disease.

Current treatments targeting HER2 could also potentially be extended to DCIS patients to reduce the chance of the cancer spreading and reduce the number of HER2-related deaths (Source: University of Nottingham).

Read the full, unabridged news story from the University of Nottingham

National Audit of Breast Cancer in Older Patients: 2019 Annual Report

Health Quality Improvement Programme | May 2019 | National Audit of Breast Cancer in Older Patients: 2019 Annual Report

The third Annual Report from Health Quality Improvement Programme describes the process and outcomes of care for 147,162 patients, diagnosed with breast cancer between 1st January 2014 and 31st December 2017 in England and Wales. The patterns of care received by people aged 70+ years are compared with the care received by people diagnosed with breast cancer aged 50–69 years. We also distinguish between the following groups of people with breast cancer:

1. Ductal carcinoma in situ.
2. Early invasive breast cancer.
3. Metastatic breast cancer.

 

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Image source: hqip.org.uk

The report is written primarily for clinicians, providers of breast cancer services, commissioners and healthcare regulators. A version for patients and the
wider public is being produced separately and will be available in summer 2019. 

National Audit of Breast Cancer in Older Patients: 2019 

 

[NICE Technology appraisal guidance] Abemaciclib with fulvestrant for treating hormone receptor-positive, HER2-negative advanced breast cancer after endocrine therapy

NICE |  May 2019| Abemaciclib with fulvestrant for treating hormone receptor-positive, HER2-negative advanced breast cancer after endocrine therapy Technology appraisal guidance [TA579]

NICE have publsihed technology appraisal guidance: Evidence-based recommendations on abemaciclib (Verzenios) for hormone receptor-positive, human epidermal growth factor 2 (HER2)-negative locally advanced or metastatic breast cancer in adults who have had endocrine therapy.

Full details from NICE 

University of Leicester research: Breast cancer relapse could be found two years earlier

University of Leicester | April 2019 | Breast cancer relapse could be found two years earlier

Research undertaken by the University of Leicester and Imperial College London and funded by Cancer Research UK,  has shown that a blood test was able to detect 89 per cent of all relapses for patients with breast cancer, with the blood test on average detecting the cancer 8.9 months quicker than imaging.

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The prospective national study enrolled 49 patients with early-stage breast cancer from three NHS trusts in the UK  who had recently completed treatment with surgery and adjuvant chemotherapy.

The study included a cross section of breast cancer subtypes, including HER2-positive, hormone receptor-positive, and triple-negative. Blood samples were collected every 6 months for up to 4 years from each patient, and results were correlated with radiographic and clinical outcomes.

Although this was an observational study, knowing that early detection of relapse could be possible presents the opportunity to conduct trials of treatments to prevent patients relapsing with symptomatic metastatic breast cancer (Source: University of Leicester).

Full press release from  University of Leicester

The study has been published in Clinical Cancer Research 

Full reference: Coombes, C. et al | 2019|Personalized detection of circulating tumor DNA antedates breast cancer metastatic recurrence |Clinical Cancer Research |  10.1158/1078-0432.CCR-18-3663

Abstract

Purpose: Up to 30% of breast cancer patients relapse after primary treatment. There are no sensitive and reliable tests to monitor these patients and detect distant metastases before overt recurrence. Here we demonstrate the use of personalized ctDNA profiling for detection of recurrence in breast cancer.

Methods: Forty-nine primary breast cancer patients were recruited following surgery and adjuvant therapy. Plasma samples (n=208) were collected every 6 months for up to 4 years. Personalized assays targeting 16 variants selected from primary tumor whole exome data were tested in serial plasma for the presence of ctDNA by ultra-deep sequencing (average more than100,000X).

Results: Plasma ctDNA was detected ahead of clinical or radiological relapse in 16 of the 18 relapsed patients (sensitivity of 89%); metastatic relapse was predicted with a lead time of up to 2 years (median=8.9 months; range: 0.5-24.0 months). None of the 31 non-relapsing patients were ctDNA-positive at any time point across 156 plasma samples (specificity of 100%). Of the two relapsed patients who were not detected in the study, the first had only a local recurrence, while the second patient had bone recurrence and had completed chemotherapy just 13 days prior to blood sampling.

Conclusions: This study demonstrates that patient-specific ctDNA analysis can be a sensitive and specific approach for disease surveillance for breast cancer patients. More importantly, earlier detection of up to two years provides a possible window for therapeutic intervention.

Rotherham NHS staff can request this article from the Library