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Press Releases

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

ESMO: Study reveals statistically significant link between breast cancer risk and air pollution

9th November 2023

Women who live and work in areas with higher levels of fine particulate air pollution are at greater risk of developing breast cancer than women who live and work in less polluted places, finds research presented at the European Society of Medical Oncology (ESMO) Congress 2023.

In a matched case-control study, researchers compared home and workplace air pollution exposure in 2,419 French women diagnosed with breast cancer against the exposure of 2,984 women without the disease from 1990 to 2011.

They found a statistically significant linear increase in breast cancer risk related to mean fine particulate matter (PM2.5) exposure, with a 28% increase in risk with an increment of 10 µg/m3 of PM2.5.

Lead author Professor Béatrice Fervers, head of prevention, cancer environment department, Léon Bérard Comprehensive Cancer Centre, France, said: ‘This contrasts with previous research which looked only at fine particle exposure where women were living, and showed small or no effects on breast cancer risk.’

In a study abstract published in the Annals of Oncology, the research term explained cases were matched to randomly selected controls based on several variables including place of residence, age and menopausal status.

All participants were drawn from the prospective E3N cohort – the French element of the European EPIC Study, coordinated by the International Agency for Research on Cancer.

Researchers using a Land Use Regression model to estimate annual mean PM2.5, coarse particulate matter (PM10) and nitrogen dioxide (NO2) and assigned them to women based on geocoded home and workplace addresses.

Mean exposure was calculated for each woman from the time they were included in the E3N cohort to their index date – the date of diagnosis of cases.

For PM10 and NO2 exposure, researchers found a numerical, but statistically non-significant, increased risk with an incremental increase of 10 µg/m3.

Hormone receptor or menopausal status did not affect any of the results, they added.

Commenting on the findings, Professor Charles Swanton, clinician scientist at the Francis Crick Institute in London, UK, said fine particulate matter can penetrate deep into the lungs, entering the blood stream and then being absorbed into breast and other tissues.

Professor Swanton, who presented research at ESMO Congress 2022 suggesting how PM2.5 particles may trigger lung cancer in non-smokers, said there was already evidence that air pollutants can change breast architecture.

‘It will be important to test if pollutants allow cells in breast tissue with pre-existing mutations to expand and drive tumour promotion possibly through inflammatory processes, similar to our observations in non-smokers with lung cancer,’ he said.

‘There is an urgent need to set up laboratory studies to investigate the effects of these small air pollutant particles on the latency, grade, aggression and progression of breast tumours.’ 

The French research comes weeks after US National Institute of Health researchers published data in the Journal of the National Cancer Institute showing living in an area with high levels of fine particulate air pollution was significantly associated with an increased risk of breast cancer incidence.

Professor Jean-Yves Blay, ESMO director of public policy, said there was strong epidemiological and biological evidence for the link between PM2.5 particle exposure and cancer, with good clinical and economic reasons for reducing pollution to prevent cancers.

In September 2023, the European Parliament adopted in plenary session its report on the ongoing revision of the EU Ambient Air Quality Directives, reflecting ESMO’s recommendations to set the annual limit value for PM2.5 at 5 µg/m³.

This adoption opens interinstitutional negotiations between the co-legislators – European Parliament, European Commission and EU Council – to agree on the final text of the directive.

Anastrozole indication expanded by MHRA to include breast cancer prevention

7th November 2023

The aromatase inhibitor anastrozole has been approved by the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) as a preventative treatment for breast cancer in postmenopausal women at moderate or high risk of developing the disease.

Previously authorised for the treatment of breast cancer in postmenopausal women, the drug has been used off-label for prevention and is now approved for this indication.

Anastrozole, which is off patent, is taken as a 1mg tablet, once a day for five years. It works by blocking the aromatase enzyme and reducing the amount of oestrogen that a patient’s body makes.

The most common side effects are hot flushes, feeling weak, pain or stiffness in the joints, arthritis, skin rash, nausea, headache, osteoporosis and depression.

According to Cancer Research UK, the entire five-year course of treatment now costs just £78, or around 4p a day.

Anastrozole was first recommended as a preventive option by the National Institute for Health and Care Excellence (NICE) in 2017, however, with the treatment being unlicensed in this use, uptake has remained low.

NHS England said around 289,000 women at moderate or high risk of breast cancer could be eligible for the drug. It estimated that if 25% of these women chose to take the drug, approximately 2,000 cases of breast cancer could potentially be prevented in England.

This would save around £15m in treatment costs, NHS England said.

NHS chief executive, Amanda Pritchard, said: ‘It’s fantastic that this vital risk-reducing option could now help thousands of women and their families avoid the distress of a breast cancer diagnosis.

‘Allowing more women to live healthier lives, free of breast cancer is truly remarkable, and we hope that licensing anastrozole for a new use today represents the first step to ensuring this risk-reducing option can be accessed by all who could benefit from it.’

The MHRA approval is based on the International Breast Cancer Intervention Study II (IBIS-II) study – an international, randomised double-blind, placebo-controlled trial.

The results showed a significant continuing reduction in breast cancer with anastrozole in the post-treatment follow-up period, and fewer women developed breast cancer in the anastrozole group compared to the placebo group.

After a median follow-up of 131 months (IQR 105–156), a 49% reduction in breast cancer was observed for anastrozole (85 vs 165 cases, hazard ratio 0.51, 95% CI 0.39–0.66, p<0.0001). The reduction was larger in the first five years (35 vs 89, 0.39, 0.27–0.58, p<0.0001), but still significant after five years.

Anastrozole is the first medicine to be repurposed through the new Medicines Repurposing Programme, which looks at using existing medicines in new ways to benefit patients and the NHS. It is hosted by NHS England and supported by the Department of Health and Social Care, the MHRA, NICE and the National Institute for Health and Care Research.

The licensing work was undertaken by Accord Healthcare on a not-for-profit basis, after Accord Healthcare was selected through an open competitive process. The Medicines Repurposing Programme will now work with the MHRA and the British Generic Manufacturers Association to ensure other companies that make anastrozole adopt the new licensed indication.

Dr David Crosby, head of prevention and early detection at Cancer Research UK, said: ‘Repurposing therapeutic drugs that have already been shown to be safe for prevention is an area with a lot of potential.

‘More research will be key to finding more opportunities like this, to better understand who is at a high risk of getting cancer, and to help lower that risk.’

Pilot project set to improve ethnic diversity in breast cancer clinical trials

11th September 2023

Greater ethnic diversity in pioneering breast cancer clinical trials is the primary objective of a recent collaborative pilot project between Barts Health NHS Trust, The Christie NHS Foundation Trust, Roche Products Ltd and Macmillan Cancer Support.

The evidence derived from randomised controlled trials constitutes the most rigorous test of efficacy, effectiveness and safety for healthcare interventions. Nevertheless, if participants enrolled in these trials do not fully reflect the wider population for which the intervention is designed, the generalisability of the findings are limited.

What’s more, a 2016 study published in the British Journal of Cancer shows that young black women with breast cancer have more aggressive tumour profiles, present with later stages of disease, have higher mortality rates and experience poorer cancer care, yet they are often under-represented in clinical trials.

In an effort to redress this imbalance, this pilot project, which will run until August 2024, aims to increase the representation of black, Asian and ethnic minority women in breast cancer trials by improving access and identifying new and better ways to disseminate information.

This will include creating more targeted and meaningful communications for the communities the project is aiming to reach; increasing data, comparative baselines and patient retention records for research purposes; and providing enhanced support to ensure breast cancer patients understand the disease, what clinical research is and navigating patients to suitable clinical trials.

Findings and recommendations from the project will be used to create a case study and framework for future clinical trials and improve representation.

Dr Peter Hall, a medical oncology consultant at Barts Health NHS Trust who is involved in the project, said: ‘It’s well known that we need to do more to improve the diversity of participants taking part in the clinical trials we run at Barts Health and indeed, across the NHS. That’s why I’m so excited about this project.

‘By taking a targeted approach to driving diversity in clinical trials for a specific disease, we can not only improve representation for this condition, but learn how we can do this for trials into other conditions too. Ultimately, it will help us be more confident that the treatments we’re providing really do work for everyone. It’s also great to see this project being run as a collaboration between the NHS, charity and the commercial sector.‘

A lack of ethnic diversity in clinical trials

Understanding why clinical trials have historically under-represented people of different ethnicities remains unclear. Some reasons include the need for a narrowly defined, homogenous population to reduce variance and hence sample size, together with the imposition of stringent inclusion and exclusion criteria.

A further possible reason is the lack of engagement with ethnic communities. According to Charles Kwaku-Odoi, chief executive of the Caribbean African Health Network, ‘across the black community there is an undoubted legacy of disengagement in research and most certainly clinical trials that stems back decades as a result of mistrust. This has not served us well because it leads to a lack of appropriate interventions that perpetuate the grave health inequalities in breast cancer care‘.

He added: ‘This partnership approach to build solutions to improve engagement in clinical trials in breast cancer treatment and care is very much welcomed. We are looking forward to working in a collaborative way to build trust, improve awareness and ensure that barriers surrounding access to clinical trials are addressed.‘

In 2020, the INCLUDE group set out a multicomponent work stream project to improve representation of under-served groups in clinical trials. Under-representation of patients from different ethnicities is a recognised problem. For instance, research has revealed a lack of ethnic diversity within lipid lowering drug trials.

EU-funded project to reduce cardiac damage from breast cancer therapy set to launch clinical trial

30th August 2023

Women receiving breast cancer therapy across six clinical centres in Europe will be enrolled in a study to determine whether behavioural and psychological interventions can reduce the cardiac damage from anti-cancer therapies.

The innovative CARDIOCARE project, which was launched in 2021 by a consortium of European partners including the European Society of Cardiology (ESC), aims to radically change the management of older women with breast cancer by harnessing the expertise of a multidisciplinary team to improve the monitoring, treatment and care these patients receive.

It is already known that breast cancer survivors have an estimated 32% higher risk of cardiovascular disease.

Now, a clinical trial evaluating the impact of behavioural and psychological interventions on quality of life, physical and mental wellbeing, and the cardiotoxic effects of breast cancer treatment will be conducted in 750 patients with breast cancer.

As part of the trial, all patients will receive the CARDIOCARE mobile app, which includes psychological and behavioural elements called ePsycHeart and eHealtHeart. Participants will be randomly allocated to receive both ePsycHeart and eHealtHeart – the intervention group or to receive ePsycHeart only.

ePsycHeart monitors quality of life, mobility and mental health using a wearable chest band heart rate sensor, smartwatch and questionnaires. eHealtHeart encourages patients to adopt behaviours such as physical activity, healthy diet, games to improve memory and changing the home environment to reduce the risk of falls.

A further aim of the trial is the early identification of women with breast cancer who are at the greatest risk of cardiac damage from anti-cancer treatments. The trial will utilise cutting-edge technologies, such as next generation sequencing, to pinpoint changes in gut microbe species that signal damage of the heart and blood vessels before symptoms occur. In addition, artificial intelligence will be used to analyse images of the heart to predict the likelihood of heart damage.

Professor Dimitrios Fotiadis, project coordinator and professor of biomedical engineering at the University of Ioannina in Greece, said: ‘Cardiovascular disease is a devastating complication of anti-cancer treatment that affects physical and mental health. CARDIOCARE will provide women over the age of 65 with breast cancer the tools to improve their physical health and to psychologically adapt to the disease.

‘CARDIOCARE is on track to improve the physical and mental health of older women with breast cancer by detecting the cardiovascular side effects of anti-cancer treatment early and providing digital tools to help patients improve their mental and physical wellbeing.‘

AI-supported mammography found to reduce radiologist workload in randomised trial

9th August 2023

Using an AI-supported mammography screening tool results in a similar breast cancer detection rate compared with standard double reading but with a substantially lower screen-reading workload, according to the interim safety findings of a new randomised controlled trial.

Making use of AI-supported software, researchers from Lund University in Sweden, have shown that a screening mammography avoids the need for double reading of all mammograms, without increasing false positives and almost halving radiologists‘ screen-reading workload.

Although previous retrospective analyses have indicated that combining AI with a radiologist improves the accuracy of breast cancer detection and reduces radiologist workload, there have been no randomised trials evaluating this approach until now.

Commenting on the findings, lead author Dr Kristina Lång said: ‘These promising interim safety results should be used to inform new trials and programme-based evaluations to address the pronounced radiologist shortage in many countries. But they are not enough on their own to confirm that AI is ready to be implemented in mammography screening.

‘We still need to understand the implications on patients’ outcomes, especially whether combining radiologists’ expertise with AI can help detect interval cancers that are often missed by traditional screening, as well as the cost-effectiveness of the technology’.

AI vs standard double reading

Published in The Lancet Oncology, the Mammography Screening with Artificial Intelligence (MASAI) trial enrolled 80,033 Swedish women aged 40-80 years who were eligible for mammography screening. Participants were randomly allocated 1:1 to either AI-supported screening (the intervention group, n = 40,003) or standard double reading without AI (the control group, n = 40,030).

The primary outcome measure of the MASAI trial was the interval cancer rate. Secondary outcomes examined included early screening performance (cancer detection rate, recall rate, false positive rate) and screen-reading workload (number of screen readings and consensus meetings).

The AI-supported system provided an examination-based malignancy risk score on a continuous scale ranging from 1 to 10. These examination were then categorised as either low risk (risk score 1 to 7), intermediate risk (risk scores 8 and 9) or high risk (risk score 10). In the intervention group, examinations with risk scores of 1 to 9 underwent single reading, whereas examinations with risk scores of 10 underwent double reading.

The cancer detection rate (per 1,000 screened women) was broadly similar, with a rate of 6.1% for the AI group and 5.1% in the control group. Similarly, recall rates were also not significantly different (2.2% vs 2.0%) and neither were the false positive rates (1.5% in both arms).

The number of screen readings was considerably lower for the AI-supported group (46,345 vs 83,231), representing a 44.3% workload decrease for reading screening mammograms.

Women treated for breast cancer show signs of accelerated biological ageing

27th July 2023

Women who are both diagnosed and treated for breast cancer appear to undergo accelerated biological ageing compared to those who remain free of the cancer, according to a recent study.

Biological aging is accelerated following a breast cancer diagnosis and treatment according to the findings of a new study led by a team from the National Institute of Environmental Health Sciences (NIEHS). Their research,

Published in the Journal of the National Cancer Institute, the researchers from the National Institute of Environmental Health Sciences examined paired blood samples through DNA methylation profiling collected from women enrolled in the prospective Sister Study cohort at the initial and follow-up visits, which were an average of 7.7 years apart.

Researchers also included patients who remained free of breast cancer for comparative purposes and used linear regression models to assess differences in several biological aging metrics at the second sample collection or follow-up by breast cancer status.

Breast cancer status and biological ageing metrics

A total of 417 women, of whom 190 were diagnosed and treated for breast cancer between blood sampling, were included in the study.

Among women who developed breast cancer, diagnoses occurred an average of 3.5 years after the initial blood draw and four years before the second sample. After adjusting regression models for covariates and biological aging metrics measured at baseline, it was found that women diagnosed and treated for breast cancer had higher biological aging metrics at the follow-up.

In analyses assessing the associations with different breast cancer therapies, radiation had strong positive associations with biological aging. In contrast, surgery had little association with the biological aging metrics.

Commenting on the study, co-author Dale Sandler said ‘Radiation is a valuable treatment option for breast cancer, and we don’t yet know why it was most strongly associated with biological age.’ He added that ‘This finding supports efforts to minimise radiation exposures when possible and to find ways to mitigate adverse health effects among the approximately four million breast cancer survivors living in the United States.’

Ribociclib with endocrine therapy improves survival in early-stage breast cancer

9th June 2023

The combination of ribociclib and standard endocrine therapy improves invasive disease-free survival rates more than endocrine therapy alone in patients with early stage, hormone receptor–positive, HER2-negative (HR+/HER2-) breast cancer, according to recent data presented at ASCO 2023.

The standard treatment for HR+/HER2- advanced or metastatic breast cancer involves the use of endocrine therapies such as aromatase inhibitors, selective oestrogen receptor (ER) modulators, and selective ER down-regulators. However, a problem with this approach is the development of treatment resistance, which therefore requires additional therapeutic strategies.

Ribociclib is a cyclin-dependent kinase 4/6 inhibitor, approved in combination with endocrine therapy for treatment of HR+/HER2- advanced or metastatic breast cancer in both pre- and post-menopausal women.

In a 2019 study, use of ribociclib and endocrine therapy significantly improved progression-free survival and had manageable toxicity in both pre- or peri-menopausal and postmenopausal women with HR+/HER2- metastatic or advanced breast cancer. However, whether this combination would benefit women with early stage breast cancer remains unclear.

The current NATALEE trial – a phase 3 multi-centre, randomised, open-label trial – is designed to evaluate the efficacy and safety of ribociclib with endocrine therapy as adjuvant treatment in patients with HR+/HER2- early breast cancer.

Ribociclib and invasive disease-free survival

In an abstract presented at the American Society of Clinical Oncology 2023, women with early stage breast cancer given ribociclib were found to have a statistically significant and clinically meaningful improvement in invasive disease-free survival (iDFS) compared to standard endocrine therapy alone.

For the trial, both pre- and post-menopausal women were randomised 1:1 to ribociclib (RIB) and endocrine therapy (ET) or ET alone for up to three years. RIB was given at a dose of 40 mg daily (three weeks on and one week off) and ET comprised letrozole 2.5 mg daily or anastrozole 1 mg day for longer than five years.

In total, 5,101 participants were randomised to either RIB and ET (2,549) or ET alone and followed for a median of 34 months. The combination of RIB and ET showed a significantly longer iDFS than ET alone (Hazard ratio, HR = 0.75, 95% CI 0.62 – 0.91, p = 0.014). In addition, the three-year iDFS rates were rates were 90.4% vs 87.1% respectively.

The abstract also reported how this iDFS benefit was generally consistent across stratification factors and other subgroups. Moreover, while not reported, the authors indicated that the secondary endpoints of overall survival, recurrence-free survival and distant disease–free survival consistently favoured RIB. In addition, at the dosage used (400 mg), RIB had a favourable safety profile with no new signals.

Cone beam breast CT superior to MRI for detection of preoperative residual tumour

20th January 2023

The use of contrast-enhanced cone beam breast computed tomography was superior to MRI in the assessment of residual preoperative tumour

Using contrast-enhanced cone beam breast CT provides a more accurate assessment of residual tumour following neoadjuvant chemotherapy compared to magnetic resonance imaging (MRI) according to the findings of a comparative study by Chinese researchers.

Neoadjuvant chemotherapy is used prior to breast cancer surgery in patients with locally advanced breast cancer to reduce the size of the tumour. An assessment of the size of unresectable residual tumour is required since this is an important factor in the local recurrence of disease following breast conserving therapy. Radiological examination has an important role in the assessment of residual tumour and MRI has been shown to be more accurate that other imaging modalities for an evaluation of the response to treatment. Cone beam breast CT is a relatively novel technique that has shown promise for the early diagnosis of malignant breast cancer and can also differentiate between malignant and benign breast tissue.

However, to date, no studies have examined the accuracy of cone beam breast CT for the assessment of residual tumour following neoadjuvant chemotherapy. In the current study, the Chinese team compared cone beam breast CT and MRI for the assessment of tumour size following neoadjuvant chemotherapy and retrospectively compared the results of the two methods with those obtained with the findings from pathology. In addition, the researchers examined the predictive value of the two approaches for a pathological complete response. The level of agreement between the tumour size based on the two methods was compared to the findings on pathology and assessed using the intraclass correlation coefficient (ICC).

Cone beam breast CT and assessment of residual tumour

Data were available for 91 women with a median age of 45 years, the majority (73.6%) of whom were premenopausal.

When compared with pathology, there was good agreement for the cone beam breast CT (ICC = 0.64, 95% CI 0.35 – 0.78). In contrast, comparison with MRI was only moderate (ICC= 0.59, 95% CI 0.36 – 0.77). In subgroup analysis, the cone beam was also superior to MRI for residual ductal carcinoma in situ (p < 0.001).

For predictive purposes, the area under the receiver operating characteristics curve for predicting a pathological complete response were similar for both imaging modalities (AUC = 0.749 for cone beam and 0.733 for MRI, p > 0.05).

The authors concluded that cone beam breast CT was superior to MRI for an assessment of residual tumour following neoadjuvant chemotherapy and could therefore be seen as an alternative means of assessment.

Citation
Wang Y et al. Accuracy of Preoperative Contrast-enhanced Cone Beam Breast CT in Assessment of Residual Tumor after Neoadjuvant Chemotherapy: A Comparative Study with Breast MRI. Acad Radiol 2023

Medical marijuana reduces opiate use among cancer patients

20th December 2022

Medical marijuana has been found to be associated with a reduced use of opiates among patients with breast, colorectal and lung cancer

Widespread state medical marijuana legalisation in the US is associated with a lower rate of opioid dispensing and pain-related hospital events among some adults receiving treatment for newly diagnosed cancer according to an analysis by US researchers.

Pain is an extremely common cancer symptom with a 2022 meta-analysis of 12 studies (10 with breast cancer and 2 lung cancer) patients, finding a pooled pain prevalence rate of 40%. Although paracetamol and non-steroidal anti-inflammatory drugs are universally accepted as part of the treatment of cancer pain at any stage of the WHO analgesic ladder, strong opioids are the mainstay of analgesic therapy in treating moderate to severe cancer-related pain. Nevertheless, with tightened regulations leading to a decrease in opioid prescribing across the United States, evidence points to a decline in opioid use among end-of-life care in those with cancer although there has been a rise in pain-related emergency department visits, suggesting that end of life cancer pain management may be worsening. Although medical marijuana has been studied and found to be efficacious for relief of pain in patients with advanced cancer pain not fully relieved by strong opioids, a 2016 review suggested that while marijuana may have the potential for refractory cancer pain, much of the data are based on animal data, small trials, or are outdated.

With the potential to help patients with cancer pain, in the current study, US researchers set out to assess the associations between medical marijuana legalisation and opioid-related and pain-related outcomes for adult patients receiving cancer treatment. The team used data from national commercial claims between 2012 to 2017. The researchers assessed several measures including the proportion of patients having 1 or more days of opioids and 1 or more pain-related emergency department visits or hospital events, during the 6 months after a new cancer diagnosis.

Medical marijuana and opiate use

A total of 38,189 patients with newly diagnosed breast cancer, 12,816 with colorectal cancer (55.4% male) and 7,190 (51.1% female) with lung cancer were included in the analysis.

Medical marijuana legalisation was associated with a reduction in the rate of 1 or more opioid days from 90.1% to 84.4% (difference = 5.6, 95% CI 2.2 – 9.0, p = 0.01) among breast cancer patients. For colorectal cancer patients, there was also a reduction, this time from 89.4% to 84.4% (difference = 4.9, 95% CI 0.5 – 9.4, p = 0.03). Finally, opioid use reduced from 31.5% to 22.1% (difference = 9.4, 95% CI 0.8 – 17.9, p = 0.03) among patients with lung cancer with recent opioids.

Medical marijuana legalisation was also associated with a reduction in the rate of 1 or more pain-related hospital events from 19.3% to 13.0% (difference = 6.3, 95% CI 0.70 – 12.0, p = 0.03) among patients with lung cancer with recent opioids. However, the difference for the other two forms of cancer was not significant.

The authors concluded that medical marijuana legalisation was associated with a lower rate of opioid dispensing and pain-related hospital events among some adults receiving treatment for newly diagnosed cancer.

Citation
Bao Y et al. Medical Marijuana Legalization and Opioid- and Pain-Related Outcomes Among Patients Newly Diagnosed With Cancer Receiving Anticancer Treatment. JAMA Oncol 2022

Long-term radiotherapy reduces local breast cancer recurrence but not overall survival

28th November 2022

The longer-term use of radiotherapy has been shown to reduce local breast cancer tumour recurrence but does not affect overall survival

Use of radiotherapy for 30 years in patients following breast conserving surgery in conjunction with chemotherapy or tamoxifen, reduces the risk of ipsilateral breast tumour recurrence but does not affect overall survival, according to the findings of follow-up study presented at the European Breast Cancer Conference in November 2022.

For a lot of women with early-stage breast cancer, breast-conserving surgery removes macroscopic disease although the presence of any remaining microscopic tumour tissue, if left untreated, could lead to loco-regional recurrence or life-threatening distant metastases. As a result, adjuvant radiotherapy, is often used and the evidence from over 10,000 women, suggests that radiotherapy to the conserved breast halves the rate at which the disease recurs and reduces the breast cancer death rate by about a sixth. In 1976, researchers began a randomised trial to determine whether lumpectomy with or without radiation therapy was as effective as total mastectomy for the treatment of invasive breast cancer. Results after 6 years showed that the relapse rate in the ipsilateral breast was 24.5% in the non-irradiated group compared to 5.8% following breast irradiation. But the researchers continued to monitor patients and the results showed that after 20 years of follow-up, there were no significant differences in overall survival among women who underwent mastectomy and those who underwent lumpectomy with or without postoperative breast irradiation. However, the study did show that the cumulative incidence of recurrent tumour in the ipsilateral breast was 14.3% in the women who underwent breast irradiation, compared with 39.2% in the women without irradiation. In the present Now, researchers are able to present 30-year survival data.

Radiotherapy and overall survival following breast cancer surgery

A total of 585 patients aged ≤70 years with early breast cancer, underwent local excision with a 1 cm margin, axillary node sampling or axillary node clearance.

Overall, researchers observed that ipsilateral breast tumour recurrence was found to be significantly lower in the radiotherapy group (Hazard ratio, HR = 0.39, 95% CI 0.27 – 0.55). For example, local recurrence (LR) after 10 years was 8.8% vs 31% (radiotherapy vs non-irradiated) but this difference reduced after 30 years and was 27.8% (95% CI 19 – 36.5) in the irradiated group and 42.7% (95% CI 35.8 – 49.6) in the non-irradiated group.

Furthermore, there was no difference in overall survival after 30 years (HR = 1.08, 95% CI 0.89 – 1.30, p = 0.43) and the proportion of survivors was broadly similar over time. For instance, overall survival at 10 years was 72.5% vs 70.8% (irradiated vs non-irradiated) and this difference was broadly similar after 30 years (23.7% vs 27.5%).

In a press release from the conference, lead researcher, Professor Ian Kunkler said, ‘We found that there is no long-term improvement in overall survival for those women having radiotherapy‘. He added that ‘The benefits of having radiotherapy in terms of fewer local recurrences are only accrued over the first ten years after radiotherapy; thereafter, the rate of local recurrence is similar whether or not patients had radiotherapy.’

Citation
Williams L et al. Randomised controlled trial of breast conserving therapy: 30 year analysis of the Scottish breast conservation trial. Abstract No 2. 13th European Breast Cancer Conference.

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