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Take a look at a selection of our recent media coverage:

EMA recommends approval of olaparib for treatment of high-risk, early breast cancer

27th June 2022

The EMA has recommended approval of olaparib in high-risk, early-stage breast cancer with inherited faults in BRCA1 or BRCA2 genes

The Institute of Cancer Research, London, strongly welcomes the news that olaparib has been recommended by the European Medicines Agency (EMA) to treat people with high-risk, early-stage breast cancer who have inherited faults in their BRCA1 or BRCA2 genes.

The next step is for the European Commission to grant marketing authorisation, a process likely to take place in the next few months. Once this licensing step is completed, people in the EU with early breast cancer and BRCA mutations, who have already been treated with chemotherapy, either before or after surgery, will be a step closer to accessing olaparib, on its own or in combination with hormone therapy.

The recommendation follows the latest findings from the Phase III OlympiA trial, which showed that adding the targeted drug olaparib to standard treatment cuts the risk of women dying by 32 per cent – resulting in more women remaining cancer free and becoming breast cancer survivors.

Professor Andrew Tutt at The Institute of Cancer Research (ICR) and King’s College London is Chair of the Steering Committee for the OlympiA trial, which was coordinated by the Breast International Group (BIG). Professor Tutt was also involved in early laboratory research at the Breast Cancer Now Toby Robins Research Centre at the ICR on PARP inhibitors such as olaparib, and their subsequent clinical development.

Olaparib, which is taken orally, was recently approved in the US for the same group of people – those with high-risk, early-stage breast cancer who have inherited faults in their BRCA1 or BRCA2 genes.

Olaparib is also approved for use in the US, EU and UK for the treatment of patients with advanced breast cancer who have inherited faults in their BRCA1 or BRCA2 genes and were previously treated with chemotherapy.

OlympiA Steering Committee Chair Professor Andrew Tutt, Professor of Oncology at The Institute of Cancer Research, London, and King’s College London said:

“Olaparib is the first PARP inhibitor to increase the chances of curing people with early-stage breast cancer after initial treatment.

“Most breast cancers identified at an early stage are likely to be cured, but even with the best standard treatments, there is a high-risk group of women who are still likely to see their cancer return. Olaparib is a targeted treatment option that can keep these women with inherited high-risk breast cancer due to BRCA1/2 gene faults free of disease.

“Today’s recommendation brings olaparib a step closer to approval in Europe for people with high-risk, early-stage breast cancer. The next steps are for the MHRA to make a recommendation in the UK, and for NICE to carry out its appraisal, so that NHS patients in England can access olaparib without delay. We hope these processes can proceed as quickly as possible given the EMA recommendation.”

Professor Kristian Helin, Chief Executive of The Institute of Cancer Research, London, said:

“Science carried out at the ICR underpinned the development of PARP inhibitors like olaparib. Initially shown to benefit those with advanced breast, ovarian and prostate cancers, olaparib could now be used to reduce the risk of disease returning in early-stage breast cancer.

“It is tremendously exciting that the OlympiA trial shows olaparib could be successfully used to treat women with early-stage breast cancer and inherited BRCA mutations to improve their survival outcomes.

“BRCA1 and BRCA2 mutations are the most common cause of hereditary breast cancer – around 5 to 10 percent of breast cancers are the result of mutations in these genes. This means that thousands of people with early breast cancer could benefit from being treated with olaparib, and I look forward to seeing BRCA1 and BRCA2 testing used more widely for those diagnosed with early-stage breast cancer, so that we can identify those likely to benefit from this game-changing targeted treatment.”

Green tea extract decreases severity of radiation-induced dermatitis in breast cancer patients

22nd June 2022

A green tea extract containing epigallocatechin-3-gallate significantly reduced radiation-induced dermatitis in women with breast cancer

A solution a green tea extract has been found to reduce both the incidence and severity of radiation-induced dermatitis in women undergoing adjunctive radiotherapy after breast cancer surgery. This was the conclusion of a phase 2 randomised, placebo-controlled trial by a team of Chinese researchers.

Breast cancer affects a large number of women and according to the World Health Organisation, in 2020, there were 2.3 million women diagnosed with breast cancer and and which led to 685 000 deaths. For the treatment of women with breast cancer, the results from a 20-year follow-up study have shown that lumpectomy, i.e., where there is removal of enough normal breast tissue to ensure that the margins of the resected specimen were free of tumour, followed by irradiation, continues to be an appropriate therapy for women, provided an acceptable cosmetic result can be obtained. However, one troublesome adverse effect of radiotherapy is radiation-induced dermatitis (RID) and while the use of topical prophylactic corticosteroids (e.g., mometasone) is recommended to reduce discomfort and itching, there is no evidence to support the superiority for any specific intervention.

To date, there is some, limited data to show that a green tea extract containing epigallocatechin-3-gallate (EGCG) can help with restitution of skin integrity, possibly mediated via an anti-inflammatory effect. Furthermore, some evidence also shows that a green tea extract can reduce the acute skin-induced reactions after radiation which include pain, the burning-feeling, itching, pulling and tenderness. However, whether the use of this extract could actually prevent the development of radiation-induced dermatitis is unclear and was the subject of the present study.

The Chinese team recruited women with breast cancer undergoing postoperative radiotherapy and then randomised them (2:1), to either the green tea extract or placebo (which was a normal saline solution). Both solutions were sprayed to the whole of the radiation field from day one of therapy and continued until two weeks after completion of treatment. An assessment of RID was made weekly using a scale ranging from 0 (no change) to 4 (worse impairment), i.e., higher scores indicate more severe dermatitis. In addition, patient-reported symptoms including pain, itch and tenderness were also included. The primary outcome was the incidence of grade 2 or worse RID whereas secondary outcomes included patient symptoms.

Green tea extract and RID outcomes

A total of 165 women with a median age of 46 years were enrolled and randomised to EGCG or placebo.

During radiotherapy as the dose was increased, RID began to occur two to three weeks after the start of treatment and the mean appearance time was delayed in the EGCG group compared to placebo (3.27 weeks vs 2.89 weeks, p = 0.001).

The incidence of grade 2 or above RID was 50.5% in the green tea extract group and 72.2% in the placebo arm (p = 0.008). In addition, symptom scores were also lower among the women receiving EGCG.

The authors concluded that prophylactic use of a green tea extract significantly reduced both the incidence and severity of RID and that the extract has the potential to become a new choice for skin care in women receiving radiotherapy.

Citation
Zhao H et al. Efficacy of Epigallocatechin-3-Gallate in Preventing Dermatitis in Patients With Breast Cancer Receiving Postoperative Radiotherapy: A Double-Blind, Placebo-Controlled, Phase 2 Randomized Clinical Trial JAMA Dermatol 2022

Adjuvant metformin of no benefit in non-metastatic breast cancer

7th June 2022

Addition of metformin to standard chemotherapy for breast cancer did not produce a significant improvement of invasive disease-free survival

Adding metformin to standard breast cancer chemotherapy in women with non-metastatic, high-risk operable breast cancer, did not lead to a significant improvement of invasive disease-free survival. This was the conclusion of a randomised trial conducted by researchers in Canada, Switzerland and the UK.

Diabetic patients who develop cancer havea 40% higher mortality risk than non-diabetics. In addition, studies have suggested that type 2 diabetes may be associated with 10-20% excess relative risk of breast cancer. The drug metformin is a biguanide that is used in the treatment of type 2 diabetes and works by decreasing gluconeogenesis and increases peripheral utilisation of glucose. In a 2015 meta-analysis of 11 studies, that compared the outcomes of breast cancer therapy in diabetes with and without metformin, the authors concluded that use of metformin in standard cancer therapy might improve both overall and cancer-specific survivals of diabetic patients. However, this is not a consistent finding in the literature. For instance, another study of over 2,300 women with breast cancer, the authors concluded that their study failed to show an association between improved survival and increased cumulative metformin use in breast cancer patients who had recent-onset diabetes. In contrast, a 2012 retrospective analysis, found that diabetic patients with breast cancer who received metformin and neoadjuvant chemotherapy had a higher pathologic complete response rate than those not receiving the drug.

However, the data in the above studies is derived from observational studies which are subject to several forms of bias. As a result, for the current study, the researchers focused specifically on metformin and undertook a randomised trial to determine whether the use of metformin in breast cancer patients without diabetes, positively impacted on treatment outcomes.

Adult women without diabetes who received standard therapy for a T1 to T3, No to N3, MO breast cancer were recruited and stratified as either oestrogen and/or progesterone receptor positive (ER/PgR +) or negative (ER/PgR -). Enrolled participants were then randomised 1:1, to 850 mg of metformin once daily or matching placebo for 4 weeks. The dose was then increased to twice daily for 5 years. Patients were followed-up at 6 and 12 months and then annually. The primary endpoint of the trial was invasive disease-free survival. Secondary outcomes included overall survival and the incidence rates for death.

Metformin and invasive disease-free survival

A total of 3649 women with a mean age of 52.4 years of whom, 2533 were ER/PgR + were recruited. However, futility was declared for the ER/PgR- group and so the analysis was restricted to the 2533 women who were ER/PgR +.

After a median follow-up of 96.2 months, 18.4% of women had invasive disease-free survival (234 in the metformin group vs 231 in the placebo arm), giving an incidence rate of 2.78 per 100 patient-years in the metformin group and 2.74 in the placebo group (hazard ratio, HR = 1.01, 95% CI 0.84 – 1.21, p = 0.93). Similarly, the risk of death was not significantly different (HR = 1.10, 95% CI 0.86 – 1.41, p = 0.47). Although futility was declared for those with ER/PgR-, among the patients who were followed up for a median of 94.1 months, there was also no difference in the level of invasive disease-free survival (HR = 1.01, 95% CI 0.79 – 1.30, p = .082). There were also no significant differences in any of the secondary outcomes.

The authors concluded that despite the evidence from observational studies, use of adjunctive metformin did not improve invasive disease-free survival in women with breast cancer.

Citation
Goodwin PJ et al. Effect of Metformin vs Placebo on Invasive Disease–Free Survival in Patients With Breast Cancer: The MA.32 Randomized Clinical Trial JAMA 2022

Aromatase inhibitors reduce risk of breast cancer recurrence compared with tamoxifen in pre-menopause

18th February 2022

Aromatase inhibitors are better than tamoxifen at reducing the subsequent risk of breast cancer recurrence in premenopausal women

Using aromatase inhibitors reduces the risk of breast cancer recurrence in premenopausal women with ovarian suppression to a greater extent than tamoxifen. This was the key finding of a meta-analysis of individual patient data from randomised trials undertaken by a team from the Early Breast Cancer Trialists’ Collaborative Group, based in Oxford, UK.

An analysis of 20 trials with over 21,000 women in 2011 concluded that 5 years of adjuvant tamoxifen safely reduces 15-year risks of breast cancer recurrence and death. Moreover, aromatase inhibitors such as anastrozole, exemestane or letrozole, which block the conversion of androgens into oestrogens, have been found to reduce recurrence rates of breast cancer by about 30% compared with tamoxifen in postmenopausal women. However, whether this class of drugs can benefit premenopausal women with early-stage oestrogen receptor positive breast cancer and ovarian suppression is unclear.

For the present study, the team undertook a meta-analysis of individual patient data from randomised trials in which an aromatase inhibitor was compared with tamoxifen for between 3 and 5 years in premenopausal women and who were receiving ovarian suppression with goserelin, triptorelin or ablation. Data were collected on patient’s baseline characteristics including age, use of chemotherapy, body mass index, tumour grade, involvement of lymph nodes etc. They set the primary outcome as recurrence of invasive breast cancer, breast cancer mortality, death but without cancer recurrence and all-cause mortality. In addition, they set pre-specified investigations for any recurrence, distant recurrence and mortality during years, 0 – 1, 2 – 4, 5 – 9 and greater than 10 years.

Aromatase inhibitors and breast cancer recurrence

The analysis included data from 7230 premenopausal women with oestrogen-receptor positive tumours.

Among these women, 888 (12.6%) experienced a breast cancer recurrence and 418 (5.9%) deaths occurred of which 54 were unrelated to breast cancer. When compared to women receiving tamoxifen, use of aromatase inhibitors led to a significant reduction in the rate of breast cancer recurrence (ratio ratio, RR = 0.79, 95% CI 0.69 – 0.90, p = 0.0005). Interestingly, the main benefit from aromatase inhibitors on the risk of recurrence was only seen in year 0 – 4 of follow-up (RR = 0.68, 95% CI 0.55 – 0.85, p < 0.0001). Between years 5 – 9, there was no further benefit (RR = 0.98, 95% CI 0.73 – 1.33, p = 0.89). The authors calculated the 5-year absolute risk of breast cancer recurrence to be 3.2% which was lower for aromatase inhibitors compared to tamoxifen (6.9% vs 10.1%). There was also a significant reduction in the risk of distant recurrence with aromatase inhibitors (RR = 0.83, p = 0.018) compared to tamoxifen but again this benefit was lost over time.

There was no difference in the risk of breast cancer mortality compared to tamoxifen (RR = 1.01, 95% CI 0.82 – 1.24, p = 0.94), death without recurrence (RR = 1.30, 95% CI 0.75 – 2.25, p = 0.34) and all-cause mortality (RR = 1.04, 95% CI 0.86 – 1.27, p = 0.68). Interestingly, women experienced a higher incidence of fractures with aromatase inhibitors (6.4% vs 5.1%).

The authors concluded that compared to tamoxifen, use of an aromatase inhibitor, reduced the absolute risk of breast cancer recurrence by 3% at 5 and 10 years. They also called for future studies to examine the effect of endocrine therapy and ovarian suppression on women’s quality of life alongside the reduced risk of breast cancer recurrence.

Citation
Early Breast Cancer Trialists’ Collaborative Group. Aromatase inhibitors versus tamoxifen in premenopausal women with oestrogen receptor-positive early-stage breast cancer treated with ovarian suppression: a patient-level meta-analysis of 7030 women from four randomised trials Lancet Oncol 2022

Breast cancer scans detected tumours in 40% of women with no risk factors

10th February 2022

Breast cancer scans in women with no recognised risk factors identified tumours in 40% of cases highlighting a need to scan all eligible women

Breast cancer scans for women with no recognisable risk factors for the disease has identified that around 40% of these women have a tumour, emphasising the need to continue scanning eligible women. This was the conclusion of a study by researchers from the Sydney School of Public Health, University of Sydney, Australia.

A 2015 systematic review of the benefits and harms of breast cancer screening concluded that for women of all ages and at average risk, screening was associated with a reduction in breast cancer mortality of approximately 20%. However, risk-stratification of breast cancer screening might improve the cost-effectiveness of the whole scanning process and at the same time, potentially reduce any associated risks. In fact, a 2018 study found that not offering breast cancer screening to women at lower risk could improve the cost-effectiveness of the screening programme, through reducing over diagnosis and at the same time, maintaining the benefits of screening. Nevertheless, little is known about the screening outcomes for women without any known breast cancer risk factors and who are therefore assumed to be at a lower risk.

For the present study, the Australian team examined the breast cancer scan outcomes for women deemed to be at the lower end of the risk spectrum. They undertook a retrospective analysis of clinical data routinely collected in the BreastScreen Western Australia (BSWA) program and included women aged 40 years and older. Although the program does stratify women in terms of their risk, i.e., those with > 2 affected first-degree relatives etc), women age 40 and over can volunteer to participate, despite not being in the target group. The researchers collected variables such as age, need for repeat scans together with information such as a previous history of breast or ovarian cancer, use of hormone replacement therapy etc. The scans were then categorised as having none of these factors verses at least one factor and age bands of 40 -49, 50 -59, 60 – 69 and > 70 years were created. The outcomes of interest were cancer detection rates at screening (CDR) per 10,000 screens and the interval cancer rates (ICR) per 10,000 women-years.

Breast cancer scans and detection of tumours

A total of 1,026,137 screens were performed including 323,082 in women aged > 40 years, who had a mean age of 58.5 years. Among the total scans, 44.7% of women had at least one risk factor although for 55.3% of screens, the women had none of the recorded risk factors.

In the screens without any risk factors, the CDR was 50 (95% CI 48 – 52) per 10,000 screens and the ICR was 7.9 (95% CI 7.4 – 8.4). Overall, in all of the scans in which cancer was detected, for 40.9% of cases, there were no recognised risk factors present.

The authors concluded that given how many of the scans identified cancers in women without risk factors, their finding did not justify less frequent screening of women without recognised risks.

Citation
Noguchi N et al. Evidence from a BreastScreen cohort does not support a longer inter-screen interval in women who have no conventional risk factors for breast cancer Breast 2022

Dietary supplements used by 40% of those diagnosed with cancer

4th January 2022

Dietary supplements have been found to be used by 40% of adults diagnosed with breast, prostate and colorectal cancer

Dietary supplements (DS) are used by 40% of adult patients diagnosed with either breast, prostate or colorectal cancer according to research by a team from the Department of Behavioural Science and Health, University College London, UK.

Survival from cancer appears to be increasing, with a 2018 global surveillance study finding that survival trends are generally increasing, even for some of the more lethal cancers. While evidence supporting various strategies aimed at reducing cancer risk in those living with and beyond cancer is rather limited, a 2018 report by the World Cancer Research fund and the American Institute for Cancer research, is clear in its view that ‘high-dose dietary supplements are not recommended for cancer prevention’, encouraging individuals to meet their nutritional needs through diet alone. Nevertheless, some data shows that cancer survivors tend to report a higher usage of DS than those with the disease.

For the current study, the authors sought to gain a better understanding the range of and reasons for, use of DS among survivors of breast, prostate and colorectal cancer. They undertook a cross-sectional survey using data from the Advancing Survival Cancer Outcomes Trial (ASCOT) and asked respondents with each of the three cancers, their thoughts about lifestyle and cancer, use of specific foods, e.g. fruits, vegetables, meat and high calorie foods together with information on the use of DS and any other non-prescribed treatments such as herbal extracts. Respondents were asked to express their views (using a Likert scale) on the perceived importance of supplements as an approach to prevent cancer reoccurrence.

Findings

A total of 1049 participants with mean age of 64.4 years (62.1% female) provided usable data for analysis. Breast cancer was the most common (54.4%) among respondents, followed by prostate (25.2%) and colorectal (20.4%). In addition, the majority were of white ethnicity (94%) and 68% had either no (34.9%) or at least one co-morbidity.

In total, 40% of respondents reported DS use, of whom, 32% believed that these supplements were important for a reduction in cancer recurrence. The most commonly used form of supplements were fish oils (13.1%), followed by calcium and vitamin D (9.1%) and multivitamin and minerals (8.2%).

Using regression analysis, the only factors significantly associated with DS use were meeting the requirements for fruit and vegetable intake (odds ratio, OR = 1.36, 95% CI 1.02 – 1.82, p = 0.039), a belief in the importance of supplements to prevent cancer recurrence (OR = 3.13, 95% CI 2.35 – 4.18, p < 0.001) and the absence of obesity (OR = 0.58, 95% CI 0.38 – 0.87, p = 0.010).

The authors concluded that DS use among cancer survivors was common and influenced by patient’s beliefs about recurrence. They added that further work was required to better understand the reasons for such beliefs and how best to provide appropriate supplement advice to those living with a cancer diagnosis.

Citation

Conway RE et al. Dietary supplement use by individuals living with and beyond breast, prostate, and colorectal cancer: A cross‐sectional survey Cancer 2021

Antipsychotic drugs raising prolactin elevate risk of breast cancer in women

20th December 2021

Antipsychotic drugs especially those elevating prolactin levels appears to be associated with an increased risk of breast cancer in women

A study of antipsychotic drugs used by women has revealed an increased risk of breast cancer, which is worse in those drugs which elevate prolactin levels. This was the conclusion by researchers from the Department of Psychiatry, Washington, US.

Over expression of the prolactin (PRL) receptor is seen in more than 95% of human breast cancers and in fact, hyperprolactinaemia inducing antipsychotics cause precancerous cells to progress to cancer via JAK/STAT5 to suppress the apoptosis anticancer barrier. However, although data shows an increasing body of evidence supporting the involvement of PRL in breast carcinogenesis, results of human prospective studies are limited, equivocal, and correlative.

For the present analysis, the US team undertook a large epidemiological study, seeking to examine breast cancer risk by categorising antipsychotic drugs based on their ability to raise prolactin levels. Using lithium and anticonvulsants as a comparator, the researchers turned to a commercial health insurance database and identified women between the ages of 18 and 64 with an outpatient prescription for an antipsychotic, anticonvulsant or lithium between 2007 and 2016. They separated antipsychotics into three categories (1, 2 and 3) based on the propensity to raise prolactin, with drugs in category 1 being the highest. Examples included in the different categories were typical neuroleptics such as haloperidol, risperidone (category 1), olanzepine (category 2) and clozapine, quetiapine (category 3). The team identified invasive breast cancer from coding in the medical records and used multivariable Cox hazard models to evaluate the risk of breast cancer and adjusted for several factors including benign breast diseases, smoking, diabetes etc.

Findings

A total of 312,702 women with a median age of 41 years were identified as new users of antipsychotic drugs and 228, 035 women with a median age of 39 years, who were new users of anticonvulsants. From the whole sample, 914 women (0.2%) with a median age of 53 years, developed invasive breast cancer.

Women with use of any antipsychotic medication has a higher overall risk of breast cancer compared to those taking anticonvulsants or lithium (hazard ratio, HR = 1.40, 95% CI 1.19 – 1.64) although after adjustment, the hazard ratio reduced to 1.35 (95% CI 1.14 – 1.61).

In fully adjusted models, for the highest prolactin elevating category (1), the adjusted hazard ratio, aHR was 1.62 (95% CI 1.30 – 2.03), 1.54 (95% CI 1.19 – 1.99) for category 2 and non-significant for category 3. When analysing by age, younger women remained at an increased risk after adjustment (aHR = 1.91, 95% CI 1.21 – 3.01) compared to women aged 51 to 64 years (aHR = 1.43, 95% CI 1.01 – 2.03).

Discussing these findings, the authors noted how women using category 1 and 2 antipsychotic drugs had a significantly elevated risk of breast cancer compared to the comparator drugs. They suggested that younger women prescribed category 1 or 2 drugs should be considered for more frequent mammography screening.

Citation

Rahman T et al. Risk of Breast Cancer With Prolactin Elevating Antipsychotic Drugs. An Observational Study of US Women (Ages 18–64 Years) J Clin Psychopharmacol 2021

HRT use increases risk of disease recurrence in breast cancer survivors

18th November 2021

Meta-analysis shows HRT use among women who have survived breast cancer is associated with a significant increased risk of disease recurrence.

Hormone replacement therapy (HRT) use for the management of menopausal symptoms in women with a history of breast cancer is associated with a significant increase in the risk of disease recurrence according to a meta-analysis by researchers from Medical Oncology 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy. Although there have been major advances in the treatment of breast cancer, the blocking of oestrogen is associated with several adverse effects which negatively impact on a patient’s quality of life. HRT use is the most effective treatment for symptoms related to a reduction in the level of oestrogen although its use in breast cancer survivors is generally avoided. Among healthy women, the use of oestrogen only HRT leads to a reduced risk of breast cancer but when oestrogen is combined medroxyprogesterone, the risk is increased. Though it is generally advised that the use of HRT is avoided in patients with a history of breast cancer it has been suggested that there is insufficient evidence to contra-indicate HRT in breast cancer survivors.

With some uncertainty over whether HRT increases the risk in breast cancer survivors who experience oestrogen depletion-related symptoms, the Italian team decided to perform a systematic review and meta-analysis to assess the overall safety of systemic HRT use and its impact on disease recurrence in breast cancer survivors. They searched all of the main databases but restricted their search to articles published in English, randomised, placebo-controlled trials with breast cancer survivors and any studies reporting on the recurrence of breast cancer.

Findings

The literature search identified 12 studies of which, only 4 were included in the final analysis examining the effect of HRT on 4050 breast cancer survivors. All trials had randomised patients to either HRT or placebo with a total of 2022 patients randomised to HRT, either oestrogen/progestogen combinations or tibolone.

There was a low degree of heterogeneity in studies and compared to the placebo group, the use of HRT significantly increased the risk of breast cancer recurrence (hazard ratio, HR = 1.46, 95% CI 1.12 – 1.91, p = 0.006). In subgroup analysis, among patients with hormone receptor-positive tumours, the risk of disease recurrence was also significantly increased in those using hormonal therapy (HR = 1.80, 95% CI 1.15 – 2.82, p = 0.010). In contrast, in patients with hormone receptor-negative disease, there was no significant increase in risk (HR = 1.19, 95% CI 0.80 – 1.77, p = 0.39). In a further analysis, the risk of breast cancer recurrence was no different between combined HRT and tibolone (HR = 1.51 95% CI 0.84 – 2.72).

Based on these findings, the authors concluded that future research should focus on finding alternatives to hormone replacement therapy for women who have survived breast cancer yet experience symptoms related to oestrogen deficiency.

Citation

Poggio F et al. Safety of systemic hormone replacement therapy in breast cancer survivors: a systematic review and meta-analysis. Breast Cancer Res Treat 2021

Cannabis used for symptom relief in nearly half of women with breast cancer

25th October 2021

Cannabis use for the relief of symptoms in women with breast cancer was reported by 42% those in a US survey of an online health group.

An anonymous survey of cannabis (CB) use found that 42% of women with breast cancer were using it for the relief of symptoms, according research conducted by the online support group, Breastcancer.org, Pennsylvania, US. The use of medicinal CB among those with cancer is not new and has previously been reported by nearly a quarter of respondents with a range of different cancer and mostly for pain relief. In addition, other work has found that 1 in 5 patients of those with cancer admitted to taking CB during chemotherapy. Although in the US, federal law states that the possession of cannabis is illegal, except within approved research settings, as of May 2021, 36 states and four territories allow for the medical use of cannabis products and in many cases, this can be for cancer.

For the present study, the researchers developed their survey and posted it online and members of Breastcancer.org were invited to participate through messaging boards, social media and email newsletters. The survey collected demographic data as well as breast cancer variables e.g., type, stage and treatment status, together with information on their use of cannabis such as timing of use in relation to therapy, e.g., before, during or after treatment, products used, sources and perceptions of the safety of cannabis.

Findings

A total of 612 completed surveys were available for analysis from women with a mean age of 57 years. A total of 64% of respondents reported being very or extremely interested in the medicinal use of cannabis, with the most common source of information being websites (67%) and family and friends (56%). However, only 39% had discussed the use of CB with their physician.

Overall, 42% (257/612) reported having used cannabis although only 23% (58) mentioned that this was specifically for medical purposes, with the remainder using it both medically and for recreational purposes. Among the 257 respondents using cannabis, 79% had used it alongside conventional treatment and 54% reported using it after the completion of therapy. The most common reasons for taking cannabis were for the relief of pain (78%), insomnia (70%),  anxiety (57%), stress (50%) and nausea/vomiting (46%). Moreover, 75% of those using CB believed that it was extremely or very helpful, at relieving their symptoms. Of more concern, was that 57% of those using cannabis stated that this was because they found no other way of treating their symptoms and how 49% stated that they were using CB in the belief that it could treat their cancer.

Interestingly, 78% of respondents somewhat or strongly agreed, that cannabis should be viewed similarly to other plant-based medicines with 71% stating that the benefits of cannabis outweighed its risks.

Commenting on their findings, the researchers noted how the use of CB during therapy was a concern, given the limited data available on interactions. In addition, they suggested that medical providers should discuss the risks and benefits of using CB in those with cancer.

Citation

Weiss MC et al. A Coala-T-Cannabis Survey Study of Breast Cancer Patients’ Use of Cannabis Before, During, and After Treatment. Cancer 2021

Artificial intelligence appears to be less accurate than radiologists in breast cancer screening

23rd September 2021

Breast cancer screening using artificial intelligence systems has been found, in the majority of cases, to be less accurate than a radiologist.

Globally, in 2020, there were an estimated 2.3 million women diagnosed with breast cancer leading to 685,000 deaths. Fortunately, improvements in survival over recent decades have been attributed to population-based breast cancer screening with mammography. In fact, a recent UK study suggested that screening reduces cancer mortality by 38% among women screened at least once.

The use of artificial intelligence (AI) systems for image recognition in breast cancer screening could lead to improvements in the detection of cases, either as a standalone system or as an aid to radiologists. Indeed, there is some evidence to support the value of AI with one retrospective analysis of an AI screening algorithm concluding that it showed better diagnostic performance than a radiologist. Nevertheless, in a 2019 review, it was concluded that while AI systems have good accuracy for breast cancer detection, methodological concerns and evidence gaps exist that limit translation into clinical breast cancer screening settings.

In light of these concerns, a team from the Division of Health Sciences, University of Warwick, UK, were commissioned by the UK National Screening Committee to undertake a systematic review to determine whether there was sufficient evidence to support the introduction of AI for mammographic image analysis in breast screening. They conducted literature searches up to May 2021 and included studies that reported the test accuracy of AI algorithms either alone or in combination with radiologists, to detect breast cancer in digital mammograms in screening practice or in test sets. The team included cancer confirmed by histological analysis of biopsy samples in cases where women were referred for further tests after screening as the reference standard or from symptomatic presentation during follow-up.

Findings
The review identified a total of 12 studies including 131,822 women undergoing breast cancer screening. In studies with a standalone AI system, the algorithm calculated a cancer risk score, categorising women at either high (recall) or low (no recall) risk. When used to assist the radiologist, the AI system simply provided a level of suspicion. In two large retrospective studies including 76,813 women, that compared the AI system with the clinical decisions of a radiologist, 96% of systems were less accurate than a single radiologist and all were less accurate than a double read.
Overall, the authors reported considerably heterogeneity in study methodology, some of which resulted in high concerns over the risk of bias and applicability. In their study, they commented that “evidence is insufficient on the accuracy or clinical effect of introducing AI to examine mammograms anywhere on the screening pathway”.

In the conclusion, the authors noted how AI systems for breast cancer screening are a long way from having the quality and quantity required for implementation into clinical practice.

Citation
Freeman K et al. Use of artificial intelligence for image analysis in breast cancer screening programmes: systematic review of test accuracy. BMJ 2021