Breast Cancer - National Knowledge Week - October 2006

  Breast self examination          Cancer cells          Women sitting on a bench          Medication

                Introduction                      Contents                       Resources                    Contributors

Introduction
Editorial by Clive Griffith, Consultant Breast Surgeon and National Lead for Breast Cancer, Cancer Services Collaborative 'Improvement Programme'

I am very pleased to be able to write an editorial for the second Breast Cancer National Knowledge Week and am grateful for the contributions from the Advisory Panel. The experts have provided their individual 'hot topics' for the last year.  The Cancer Specialist Library has identified, where possible, high quality evidence relevant to these topics.  The aim is to help put the new information into focus and to support clinicians and patients making treatment decisions. Some of the interesting contributions this year include:

HER2 testing
A recent survey (not published yet) by the Association of Breast Surgeons reported that only 40% of newly diagnosed breast cancer patients had routine testing for HER2.This is disappointing in that the rationale for testing all new breast cancers for HER2 is that we can inform the 75% who test HER 2 negative that they will not benefit from Herceptin whilst directing the 25% who test HER2 positive towards an appropriate therapy that will improve their chances of long term survival.

It is hoped that current trials about the duration of treatment with Herceptin, will answer whether one or two years is the optimum period.

Sentinel node biopsy
The 'Newstart' programme organised by  the Royal College of Surgeons of England will enable surgeons in breast units to be trained in sentinel node biopsy techniques.

Patients with breast cancer need appropriate axillary surgery so that only if the nodes are involved, will axillary clearance be undertaken. Less problems with shoulder mobility and lymphoedema should result. It is important to ensure that patients with involved nodes have either axillary clearance or directed axillary radiotherapy.

2 weeks for all
It is known that up to 30% of patients eventually diagnosed with breast cancer present via the 'non-urgent' referral route as opposed to the 70% that are appropriately referred from primary care, via the '2 week wait' urgent referral programme.

Patients in the 'non-urgent' group are often significantly younger but present with the same signs and symptoms as those in the urgent referral group.

In order that all patients with breast cancer are diagnosed and treated as early as possible, women with breast symptoms regardless of age or the level of suspicion by the primary care team, should be seen within two weeks of their referral from primary care. Breast clinics are at full capacity at present and this initiative will require innovative ways of increasing the diagnostic capacity in order to accomplish this target.  Strategies may include employing nurse or radiographer practitioners to see patients, in addition to consultation with a breast surgeon.

Aromatase inhibitors
There is increasing evidence to suggest that post menopausal women with oestrogen receptor positive breast cancer switch to an aromatase inhibitor after two to three years of tamoxifen therapy.   Data from a number of clinical trials has reported this is beneficial in terms of disease free survival and guidance has been developed by Cancer Networks and NICE .

Basic science
There are exciting areas of research that hold out promise for advances in targeted therapy and prevention of breast cancer in high risk patients.

Defects in BRCA 1 and 2 drive tumour formation for breast and ovarian cancer and PARP (polyADP-ribose polymerase) inhibitors directed to BRCA 1 and 2 defective cells, show promise to be therapeutic with cancer cell death.  This may also prove prophylactic in BRCA 1 and 2 gene carriers and reduce risk of tumour formation without resorting to surgical removal of breasts and ovaries.

Radiotherapy
Trials have shown that reducing the duration of radiotherapy can achieve equivalent efficacy to prolonged treatment regimes.This should reduce the time that patients with breast cancer wait for radiotherapy without compromising the effectiveness of treatment.

We hope that this update to the Breast cancer knowledge will help users keep up-to-date with the latest developments.  Topics have been suggested by the Advisory Panel and the Library uses rigorous methods to find, quality check and present the information featured in the Knowledge Week.  Please send us your feedback and take 5 minutes to complete the survey.

See the Contents page for each section referred to in this Editorial.
Further information about our methods can be found in our Development Policy.
Visit the Knowledge Update Section on breast cancer for further collections of current resources.

16th October 2006