We report from the largest breast cancer conference in the world, the San Antonio Breast Cancer Symposium, which happened online in 2020. Talks at the conference echoed the main topics dominating the news last year and discussed breast cancer research progress.
The global impact of the pandemic
The COVID-19 pandemic has affected breast cancer care around the world. Clinicians, researchers and patients shared their experience.
Dr Deborah Doroshow, from the Tisch Cancer Institute in New York, highlighted that the pandemic has affected ethnic minority cancer patients more. People from ethnic minorities are more likely to be front-line workers or live in bigger families spanning multiple generations, which could at least in part explain this trend. Whilst her talk was focused on the events in the US, we know that people from ethnic minorities are also disproportionately affected by COVID-19 in the UK.
Living with breast cancer and COVID-19 was also discussed. Dr Lidia Schapira from Stanford University, USA, talked about what “resilience” means for breast cancer patients. She highlighted the need for psychological support that breast cancer patients as well as their families and carers may need in times like this.
Inequality in breast cancer care
A special session at the symposium examined the diverse factors driving inequalities in breast cancer research and treatment. It brought together the views of patient advocates from the Tigerlily Foundation as well as researchers and clinicians to discuss racial disparities.
The session highlighted how black women face systemic barriers to accessing treatment. But there are also barriers to black and other minority ethnic communities being involved in clinical trials that shape how breast cancer is treated. Many problems were highlighted that need to be addressed to overcome these disparities. Some of them relate to genetics or lack of research into how the disease affects ethnic minorities. However, the biggest impact on health inequalities seems to stem from both historic and existing discrimination.
For example, breast cancer screening currently doesn’t work well for black women. Most, if not all, cancer risk assessment tools are based on genetic studies that massively under-represent black women. And so they don’t accurately estimate their chances of developing the disease. Therefore, to more accurately predict their risk of breast cancer we need risk assessment tools that are based on the right data.
The overall take-home message was that we need to question this inequality in breast cancer research, diagnosis and treatment, and address the underlying issues to bring about change.
Can we tell which secondary breast cancer patients will benefit from ribociclib?
Professor Aleix Prat from Hospital Clinic Barcelona, Spain, who is also carrying out Breast Cancer Now-funded research, wanted to understand how we can distinguish secondary breast cancer patients who will benefit from a combination of the drug ribociclib and the hormone therapy fulvestrant from those who won’t. Recent clinical trials have suggested that this combination can be used to treat secondary oestrogen receptor positive (ER+) breast cancer and prolong the period before the disease gets worse.
Analysing the data from these several trials, Professor Prat suggested that grouping patients according to ‘intrinsic subtype’ of their cancer, which is based on genes that are turned on or off in the tumour, could help. Patients with one intrinsic subtype, called basal-like, didn’t seem do benefit from this treatment. But further studies are needed to confirm the usefulness of determining the intrinsic subtype of breast cancers to predict their response to treatment.
The use of radiotherapy to treat women aged 65 or older
Professor Ian Kunkler from the University of Edinburgh, whose other research we also fund, presented the results from the PRIME 2 trial. This trial looked at whether women aged 65 or older diagnosed with early breast cancer benefit from radiotherapy given after breast-conserving surgery.
During five years since treatment, radiotherapy reduced the risk of cancer returning to the same breast from 4.1% to 1.3%, when comparing women who received radiotherapy to those who didn’t. At 10 years since treatment, the risk has changed to 9.8% for no radiotherapy compared to 0.9% in women undergoing radiotherapy treatment. However, while omitting radiotherapy increased the chances of cancer returning to the same breast, it didn’t have any effect on women’s survival. So it could be down to a woman’s personal choice whether to receive radiotherapy or not, after discussing the pros and cons in detail with the treatment team.
Who should be offered BRCA testing?
A couple of talks discussed genetic testing for the BRCA genes. Dr Mary-Claire King, who linked alterations in the BRCA1 gene with breast and ovarian cancers in the early 1990s, called for universal testing for women above the age of 30 to prevent more cancers. She explained that about half of women with changes in the BRCA1 and BRCA2 genes who go on to develop breast or ovarian cancer have no family history of the disease. With genetic testing becoming an easy, reliable and affordable method, it could help to identify more women at risk.
Whether everyone already diagnosed with breast cancer should be offered genetic testing was also discussed. Dr Mark Robson, from Memorial Sloan Kettering Cancer Center, argued that it would not only help to find individuals in the affected person’s family who may be at risk, but it could also help guide breast cancer treatment. For example, it would tell who could benefit from treatments such as PARP inhibitors. While Dr Susan Domchek, from the University of Pennsylvania, highlighted that it may not be appropriate to test everyone, especially since we still don’t know how some changes in genes influence the risk of the disease. It may make more sense to offer genetic testing to women diagnosed at a younger age and limit the genes we’re looking at to those with the strongest link to breast cancer, such as BRCA1, BRCA2 and PALB2.
Tackling depression in younger women with breast cancer
Dr Patricia Ganz, from the University College Los Angeles, presented her work on assessing two ways that could help improve the quality of life for younger women with breast cancer. One was a course teaching women mindfulness techniques and the other was an education programme comprised of seminars and discussions focusing on the life after breast cancer. Symptoms such as anxiety, sleep disturbance and hot flushes significantly improved in both groups, but fatigue only improved significantly in the mindfulness meditation group. The talk highlighted how much younger women with the disease can benefit from additional support, and we’re proud that our services designed for younger women have many of the elements that were shown to help.
These were just a few of the many research talks that were presented at this year’s virtual SABCS and it was great to see that the progress in breast cancer research hasn’t stopped.
You can find out more about the research we are currently funding through our information pages.