At Breast Cancer Now we fund research into both the causes of breast cancer, and how to prevent the disease, which we believe will be vital in achieving our goal to stop women dying of breast cancer by 2050. But what if we were to channel more energy into one of these approaches?
That’s the question we put to the audience at the National Cancer Research Institute (NCRI)’s annual conference on a foggy Sunday evening in Liverpool on 1st November.
In a packed auditorium, four leading experts passionately laid down their cases for and against the motion: “This house believes we should stop focusing on the causes of breast cancer and get on with strategies to prevent the disease.” Many in the audience came with views to share too.
An initial vote showed that the crowd was pretty evenly split in their thoughts on the topic at hand, providing a balanced room for the panel to launch their opening arguments into.
Professor Rob Coleman, one of the Trustees at Breast Cancer Now, introduced a “stellar faculty” on the panel and launched what he rightly predicted would be a “lively, educational and scientific” debate.
Pleas for prevention
Professor Annie Anderson opened her remarks with 'a story' - in her lifetime she has seen the incidence of breast cancer cases rise by 72%, and that’s just in the UK. “We have to think about that worldwide picture,” she added.
How to turn that rise around? Firstly, more funding of prevention research is needed. Prof Anderson pointed out that from 2009-2013 the research spend from NCRI partners (including Breast Cancer Now) on the best ways to intervene in people’s behaviour to prevent breast cancer was £890,658 compared to almost £6 million for research into causes of the disease.
Secondly, Prof Anderson believes, “Breast cancer is a public health problem and needs large-scale public health approaches to change behaviours.”
From her perspective, the screening programme should be harnessed to help people change their behaviours, or at a very minimum, to deliver information on how lifestyle factors – gaining weight, being inactive and drinking alcohol - can increase breast cancer risk.
Bringing further backup for the 'for' case was Professor Gareth Evans’ sonorous voice. He was clear what his goal was - “We’re not saying don’t fund the causes, just focus more on prevention.”
From his perspective, nearly 30% of all breast cancer cases occur in women at a high risk – so we can start preventing all those cases right now.
This can either be done with drugs or with lifestyle approaches, or both. He gave examples of a study his colleague Dr Michelle Harvie is running of an exercise and diet programme, which is proving popular in women who know they have a high risk of developing breast cancer, and he has also seen a real interest in drugs for preventing breast cancer, such as raloxifene, in this group of high risk women.
“It is the time now to act!”, he finished.
Cajoling for causes
Professor Doug Easton jumped straight in with examples of where discoveries about the causes of other cancers has helped us to prevent them – tobacco and lung cancer, viruses like HPV and cervical cancer, and occupational risks like asbestos and mesothelioma.
His point being we haven’t got a prevention approach as good as any of the above for breast cancer yet so we need more research into causes. He said of current approaches to prevention they’re 'drastic with surgery', have too many side effects with prevention drugs, or are 'difficult to organise and get people to stick to' for weight loss and exercise.
He believes we can do better in the coming years if we can find out more about the causes of breast cancer and then use that knowledge to find better ways to prevent it. He acknowledged it will be tough to learn more, but added “We do have a lot more technologies we can apply to find the causes,” which he then listed.
Second on the 'against' side was Professor Tim Key. He similarly argued that the tools we have to prevent breast cancer at the moment just aren’t good enough in order "to reduce rates as much as we want… and that means making it a rare disease.”
Prof Key put forward that if we can better understand the biology of factors that we already know can reduce the risk of breast cancer, like having children early and breastfeeding, we can mimic their effects with drugs.
This, he argued, is more realistic than no-one being overweight or ever drinking alcohol.
An invite for interrogation
Questions came in thick and fast once the speeches were done, with panel members on both sides of the motion fielding multiple questions.
Prof Evans was lambasted for only focussing on women at high risk of the disease but he countered this with a call for urgency - “Let’s turn the juggernaut of increasing cancer rates cases around now.”
However, Prof Easton saw this as a lack of ambition and reinforced his view that “we’re not going to prevent the majority of cases with the existing strategies.”
There was a point made that a high proportion of women stop taking their tamoxifen as drug for treating breast cancer, and does this mean women will find it hard to stick to for prevention purposes?
Both sides agreed we need to get better at predicting which patients will benefit from tamoxifen, which could help motivate them to continue with their course of treatment.
Prof Key gave some more detail on the topic of mimicking pregnancy with drugs and another crowd member said, “Why are we not talking about drugs like aspirin?” There was a suggestion that all of these things could be part of a 'poly-pill' in the future that prevents many cancers.
Social issues of policy and educating people about cancer risks from a young age on also came up, to which Prof Anderson repeated her call to take a broad public health approach and do research that forces policy makers to take action.
And the winner is…
After the last questions were addressed by the panel, Prof Coleman stood again to ask the audience to vote and the winner was…
For the motion to focus on prevention!
The opposing side graciously accepted defeat and everyone applauded both teams for their passionate and good-humoured debate.
Overall, this event was a vital reminder of the fact there’s still so much more for us to learn about the best ways to prevent breast cancer. That learning needs to happen right now with prevention trials and also by looking to the future and learning more about causes of breast cancer to inform future prevention approaches. That’s why Breast Cancer Now is taking action on both sides of this debate.