Pathway to promise
It’s international Breast Cancer Awareness Month and the UK’s biggest killer needs attention.
Breast cancer has been the most common cancer in the UK since 1997*, and 1 in 8 women in the UK will develop breast cancer in their lifetime. During Breast Cancer Awareness Month, around 5000 people will be diagnosed with the disease, with one person diagnosed every 10 minutes.
Things are improving, however – in the UK, breast cancer survival has doubled in the last 40 years, while almost 9 in 10 women survive breast cancer for five years or more. Despite this, around 11,400 people die from breast cancer in the UK every year.
Novartis: At the time of going to press, Novartis was waiting for NICE’s decision on whether Kisqali (ribociclib) will be funded by the NHS. Following the drug’s authorisation from the European Commission in August for the treatment of advanced breast cancer, ribociclib is now licensed for use in Europe as a first-line treatment in combination with an aromatase inhibitor in postmenopausal women with hormone receptor positive, human epidermal growth factor receptor-2 negative (HR+/HER2-) locally advanced or metastatic breast cancer.
Roche: After suffering the setback of provisional rejection by NICE in December 2016, Roche’s Kadcyla (trastuzumab emtansine) was the subject of what was dubbed a ‘monumental U-turn’ by the media earlier this year, as the manufacturer agreed a deal with NHS England to make the drug available to around 1200 women per year with advanced aggressive cancer.
Pfizer: In February this year, NICE made the provisional decision that Ibrance (palbociclib) should not be routinely funded on the NHS in England. Its final appraisal was paused for Pfizer to present further clinical data.
Then in May, Pfizer made the unexpected announcement that it would give out palbociclib for free until NICE makes its decision on whether it should be available on the NHS. At the time of going to press, palbociclib was still being given to women with incurable metastatic breast cancer at no cost.
AstraZeneca: Promising trial results for the PARP inhibitor Lynparza (olaparib) were recently revealed. Results from the Phase III OlympiAD trial found a 42% reduction in the risk of the disease spreading in patients taking Lynparza, compared to those undergoing chemotherapy.
Professor Arnie Purushotham, Cancer Research UK’s senior clinical adviser
Recent technological developments have enabled the study of cancer’s molecular and genetic characteristics in unprecedented detail, shifting the view of breast cancer as, not one disease, but a collection of unique diseases with their own challenges. This has ushered in a wave of exciting research into tailoring treatments to each person’s individual cancer, so patients get treatments that are right for their disease.
Coupled with this progress has been finding less invasive techniques to take a detailed snapshot of each person’s tumour, which could help guide therapeutic decisions. Liquid biopsies, blood tests that fish out fragments of tumours for analysis, are increasingly occupying this role. In the future, these innovative methods may have a role in diagnosing the disease earlier.
But just as it’s crucial to ensure patients get treatments that are best for them, it’s essential to prevent harm from giving people treatments that they don’t need. One of Cancer Research UK’s Grand Challenges seeks to address this issue by determining how to distinguish between those who do need treatment and those who don’t in women with a condition called ductal carcinoma in situ (DCIS), which can sometimes develop into breast cancer. This work could spare thousands of women unnecessary treatment.
Does it add up?
Breast Cancer UK’s ‘You Do the Maths’ campaign shines a light on the relatively small amounts currently spent on understanding and preventing the causes of cancers, and asks whether more can be invested to help prevent breast cancer.
• 75% of breast cancer cases thought to be attributable to environmental and lifestyle causes
• 1% of research funding spent on environmental and lifestyle causes of cancer in 2014
• It is estimated that 20-30% of cases are due to genetic mutations. Of these, 2-3% are associated with BRCA mutations
• £51m is the estimated annual cost savings if the incidence rate for breast cancer was reduced by 10%.
Katy English, 24
“It looks like you’ve got cancer,” said the registrar, without warning, or sensitivity. I instantly went numb and completely shut down. My mum, panicking, asked questions: “How are you going to treat it, you’ll be able to sort it out won’t you?” “What, you want me to go through all the treatment options now?” he said with disdain.
We were led away by a breast care nurse, who came to be an invaluable guide throughout. Luckily that first registrar was the only detestable character who played a part in my care; the oncologist, surgeon, chemo nurses and breast care nurses (all women) were outstanding.
At 24-years-old, being told I had cancer was unbelievable, devastating, horrifying. Until then I was a ‘normal’ twenty-something; recently graduated, proud to have moved out of my parents and in with my boyfriend and best friends from school, and even prouder to have just been offered a place to start a PGCE.
I hadn’t been worried when I felt a lump in my breast, they often felt a bit lumpy or bumpy at different times of the month, but I made a doctor’s appointment when I noticed the bottom of one breast looked flatter than the other when I raised my arms. The GP immediately referred me for tests. That was when my whole world turned upside down.
They decided that as the lump was large and my lymph nodes tested positive, I would have six rounds of chemo, to hopefully shrink the lump before surgery to lose less of the breast. Chemo was hard. My family and boyfriend were by my side through everything, I couldn’t have done it without their infinite love and patience.
I wanted a double mastectomy and my surgeon and I both had to appeal for it to be approved, after initially being rejected, but it went ahead on the 22nd of December. I was discharged on Christmas Eve.
I then had three weeks of radiotherapy every day, and now I have to take oestrogen blocking tablets for 10 years, which give me hot flushes and achy joints and muscles, but I have gradually regained energy.
I recently swam 25km in a month and raised £3500 for Bart’s Charity Breast Cancer Research Fund, and I am due to start my PGCE. The last year has been an enormous challenge, but I feel stronger than ever and pray that it never comes back.
Making an impact
What difference have breast cancer campaigns made?
Race for Life
Over the past 20 years, over 8 million women have taken part in Cancer Research UK’s events, from 5k runs to muddy obstacle courses, raising over £547 million to fund research.
Wear it pink day
Rock a pink cowboy hat in the boardroom, wear a pink feather boa to walk the dog – it doesn’t matter, as long as you do it in support of Breast Cancer Now on Friday 20 October. The campaign has raised £30.1 million to date for breast cancer research.
In a mission to educate us that young people get breast cancer too, the charity, headed by the inspirational Kris Hallenga, has launched many campaigns encouraging women (and men) under 30 to regularly check their boobs. These include Check ‘em Tuesday, the Bra Hijack, the Coppafeel! Boob Tour, and #GetItOffYourChest. Read Kris’s remarkable story on p18.
Men get breast cancer too
Breast cancer is not an exclusively female disease – although it is rare, male breast cancer accounts for 1 in every 100,000 males. According to Cancer Research UK, data shows that male breast cancer mortality is strongly related to age, with the highest mortality rates being in older males. In the UK in 2012-2014, on average each year around 6 in 10 (55%) of deaths were in males aged 75 and over.
If you are concerned about breast cancer, need advice or would like to talk to someone, call 0808 800 6000 or go to breastcancercare.org.uk