Download Tackling breast cancer

Tackling breast cancer
To mark Breast Cancer Awareness Month, Professor Gordon Wishart, Professor of Cancer Surgery and
Chief Medical Officer at Check4Cancer – talks about the importance of early breast cancer detection,
genetic testing and breast cancer risk factors, and how women can help to reduce their own risk.
You have referred in the past to breast cancer and its treatment as “a success
story” – why is that?
Like other types of cancer, the incidence of breast cancer is increasing, with around 53,000 new cases in
the UK per annum. However, breast cancer survival is improving and has doubled in the last 40 years in
the UK. According to figures from Cancer Research UK, breast cancer has a 78% survival rate, making it
one of the most successfully treated cancers.
To put this into perspective, it’s helpful to compare breast cancer with lung cancer. This is the second
most common cancer in the UK after breast cancer, but has a much higher mortality. There is no
screening programme at all for lung cancer, and 90% of cases come to light as a result of symptoms such
as weight loss, or coughing up blood. By the time this happens, however, it is already too late for
effective treatment. 45,525 new cases of lung cancer were diagnosed in UK in 2014 – a slightly lower
incidence than breast cancer – but by comparison the number of deaths is huge. There were 11,433
deaths from breast cancer in the UK in 2014, but 35,895 from lung cancer. If lung cancer could be
detected at an earlier stage like breast cancer is, we could expect to see the number of deaths reduced
by as much as two thirds.
As with all forms of cancer, early detection is key to effective treatment – and high levels of awareness
and a national screening programme have made a huge impact. So, breast cancer really is a success story
– but we can still do better, and part of that involves encouraging all women to be breast aware and have
regular screening.
How important are regular self-exams?
Women themselves are the first line of defence when it comes to breast health, not only by moderating
lifestyle factors that affect their risk but because they are best placed to detect unusual changes in their
own bodies. So often cancer makes us feel that we are not in control of our health, but self-checking
gives some of that sense of control back. More importantly, it also saves lives: around 90% of breast
lumps are found by women themselves.
As many women lead busy lives, remembering to self-exam at a certain time of the month is not always a
top priority. At Check4Cancer we have introduced a monthly alert service to send you a monthly alert by
email to remind you of the optimum time to conduct your self-examination. For more information, please
click here.
How can we improve on what we have?
One way is through more targeted or risk-stratified screening, taking into account medical history and
family history in a more sophisticated way, so that we can concentrate screening those who are at higher
risk of developing breast cancer. At Check4Cancer – we offer testing to women in a younger age range
than the NHS standard range of 50+, often as a benefit through their employers – we start the process
with a questionnaire about lifestyle and family history, then a thorough examination with an experienced
nurse. Only then are women who are considered at higher risk referred for mammography. This keeps
over diagnosis and overuse of mammography to a minimum. I believe this is the way forward. The better
we in the UK target our screening services, the higher the success rate will be – and the more confidence
women will have in it.
Genetic testing has figured prominently in the press over the past couple of
years – how can this help?
There have been several high profile celebrity cases recently – Angelina Jolie being one – which have
highlighted the role that genetic testing can play in identification of women who have an extremely high
risk of getting breast cancer in their lifetime. We now know that carrying certain genes, such as the
BRCA1 & BRCA 2 genes, significantly increase a woman’s chances of developing breast cancer. Armed
with this information, Angelina Jolie was in a position to take preventative steps, and in 2013 she opted
for a double mastectomy. While this is clearly a radical move, it has reduced her risk of breast cancer
from 87% to a minimal level. Women who have inherited a BRCA mutation can also choose to have more
frequent breast screening from an earlier age or, they can choose to take drugs like Tamoxifen to lower
their risk. Genetic testing should always be linked with counselling before and after testing to help
women make the right choices for them as an individual.
What about other lifestyle factors?
Obesity, especially in post-menopausal women, increases breast cancer risk. There is also plenty of
evidence to show that the risk of breast cancer, in particular, is directly proportional to alcohol intake.
Recent US research published in the British Medical Journal, showed that even light to moderate intake
of alcohol increases breast cancer risk. Women themselves are the first line of defence when it comes to
breast health, not only by detecting unusual changes in their own bodies, but also moderating lifestyle
factors that affect their risk. When it comes to early detection of cancer, this new information will also
help all clinicians to fine-tune their risk assessment criteria, and that, ultimately, will save lives.
Some risk factors that we might consider “lifestyle choices” are also connected to women in the
workplace. Factors now known to increase risk of breast cancer include having no children or having
them late in life (that is, after the age of 25) and not breast feeding. We know that many women put off
having children, or decide not to have them at all, because of a desire or need to work. The downside of
this, however, is increased breast cancer risk. This is nothing to do with their specific working
environment, of course, but is nonetheless a result of the pressure on women to have both career and
family.
Also, those involved in shift work have an increased risk of breast cancer. A third of women in the UK
work shift patterns that include an element of night shift work, and we now know that over a prolonged
period of time this increases breast cancer risk by as much as 50% (in men, shift work carries a similar
increased risk of prostate cancer). In fact shift work was declared a carcinogen by the International
Agency for Research on Cancer (IARC) in 2007, and this increased risk has been confirmed by the Health
& Safety Executive in the UK.
How do you see the fight against breast cancer being carried into the future?
Often people talk in terms of a “cure” for cancer, but in reality I think it is more about tackling it on a
whole variety of fronts. We are finding new ways to detect and treat it all the time and, although they
predicted breast surgeons would soon be extinct when I was still at medical school, breast surgery
remains the single most important element of curative treatment. In my opinion, much of the success in
reducing mortality from breast cancer during the last 15-20 years can be linked to early detection, the
development of breast cancer specialist teams and breast screening. I believe that future improvements
will rely on better identification of high-risk groups with refined genetic testing for women without a
family history (SNP testing), increased use of risk-stratified screening and the development of new
targeted therapies that are directed against specific products of the tumour cells.
I also believe, partly for reasons already described, that employers will have an increasing part to play. In
our experience, many employers are already finding that by offering employees cancer checks as a
benefit they can not only save lives, but cut down on health insurance costs and increase employee
engagement. It’s a win-win for both employer and employee, so I hope this will add an extra dimension
and increased impetus to the fight.
Professor Gordon Wishart – former clinical director of the Cambridge Breast Unit – is visiting Professor of
Cancer Surgery at Anglia Ruskin University and has an international reputation in the field of clinical
breast cancer research. He is also Chief Medical Officer of Check4Cancer – a company dedicated to
tackling cancer in the workplace.