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6 Funding world-class research We ve combined the long-term, expert programmes run from dedicated research centres and units funded by Breakthrough Breast Cancer with the wider geographical spread and rapid response-mode approach of Breast Cancer Campaign s grant funding. Together these now form one exceptional programme supporting the most cuttingedge research across the UK and Ireland. We re reaching further and doing more than ever before. It means we can support the brightest and best scientists and projects at the right time and in the right way. It means more women benefit from our research, faster. The environment we re working in is more collaborative and more innovative. We re building a global scientific community focused on addressing the critical gaps in breast cancer knowledge and research. It means we can ask the biggest questions, and work together to answer them. It means we ll make the discoveries, sooner. But research doesn t happen overnight, which is why our funding is focused on the future as well as on the here and now. We re supporting nearly 450 researchers, including many of the world s top breast cancer scientists. We re also committed to nurturing talent and encouraging potential by championing PhD students and those at the start of their breast cancer research careers. It means we re combining prestige with pioneer, expert with innovator, to tackle the disease from all angles. It means we ll always stay one step ahead. Working from the laboratory bench to the hospital bedside and back again High-quality research is how we ll stop breast cancer taking lives but that research has to be supported by robust policy campaigns that make the voices of patients and their families heard, and public health campaigns that empower everyone to take action. We re the catalyst that connects the laboratory bench with the hospital bedside, the GP s office, the MP s surgery and the policies that govern our health service tethering every breakthrough to the women it was made to help. And it s only by bringing together everyone affected by the disease with everyone working to end it that we ll truly make a difference. Acting now to stop breast cancer Right now, breast cancer research is at a tipping point. The challenge is vast. But building on the legacies, strengths and advances made by Breast Cancer Campaign and Breakthrough Breast Cancer, we ve identified the steps we need to take next. We know we can never eradicate breast cancer entirely. But we can find ways to prevent it, detect it and treat it so effectively that no one dies from it ever again. If we all act now, by 2050, we believe everyone who develops breast cancer will live. We ve got a once in a lifetime opportunity to make that happen. 10 Introduction Introduction 11
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8 Research holds the key to a world where everyone who develops breast cancer lives. By 2025 As a result of increased research, we believe 25 per cent fewer people will develop secondary breast cancer We believe we can reach three quarters of women with our bespoke breast awareness message and increase screening uptake back to its highest ever levels, saving at least 1,500 women s lives each year We believe we will be able to prevent up to 15 per cent of breast cancer cases We believe we will have identified those at increased risk of breast cancer so a further 2,850 women each year will have their disease diagnosed early. And by knowing which breast cancers require treatment and which don t, we aim to eliminate overtreatment, saving over 4,000 women from unnecessary treatment each year We believe we will have identified what causes different tumours to grow and progress, enabling us to select the best treatment for every patient We believe over 50 per cent of those diagnosed with secondary breast cancer will survive beyond five years We believe that we will be able to prevent 30 per cent of breast cancer cases and that those who get breast cancer will live. 14 Introduction Introduction 15
9 Our work will focus around four critical areas 01. Risk and prevention 02. Early detection and diagnosis 03. Treatment 04. Secondary breast cancer The best weapon we could have against breast cancer is the ability to stop it occurring in the first place. To do this, we need to know who is most at risk of breast cancer and what we can do to prevent them from developing it. The earlier breast cancer is found and the earlier treatment is started, the greater the chances are of surviving the disease. Breast awareness and breast screening are vital ways to ensure women are diagnosed early. Breast cancer is not just one disease there are more than 20 different types of breast cancer that we know of. That s why treatments must be highly targeted, personalised to each individual and their particular form of breast cancer. But there s more we need to know before we can truly fit the right treatment to the right person. Secondary breast cancer breast cancer that s spread to other parts of the body kills 1,000 UK women a month. At present, secondary breast cancer is not curable, but we will fight to change this by ramping up research efforts to stop women dying from the disease and work to ensure that women living with secondary breast cancer receive the best possible care. We must: We must: We must: We must: Understand how genetic, hormone and lifestyle factors lead to the development of breast cancer, and use this knowledge to accurately assess an individual s personal risk of the disease. Identify sustainable lifestyle changes, such as diet and exercise, which can reduce the risk of breast cancer and help women understand how making these changes could benefit them. Find the best risk-reducing interventions for women at increased risk of breast cancer, and ensure these are made available and used as effectively as possible. Ensure that the policy and public health environment responds to the latest evidence to deliver effective risk and prevention tests and treatments, as well as policies to support healthy, active lifestyles and improved public health in order to prevent more breast cancer cases. Find new ways to detect breast cancer at its earliest stages and ensure that this knowledge is implemented. Monitor developments in the stage at which breast cancer is detected across different areas and groups, and raise awareness of the signs and symptoms of breast cancer, giving women the confidence to take any concerns to their doctor as quickly as possible. Develop better methods of differentiating between very early breast cancers that require treatment and those that don t, avoiding over-diagnosis and over-treatment. Work with government, clinicians and the NHS to improve earlier diagnosis and detection by monitoring and influencing the quality of breast cancer services, including GP referral pathways, to ensure they re working as best they can. Advance our understanding of the genetic faults that drive breast cancer and allow it to become resistant to treatments, which will lead us to more personalised treatments. Ensure continued government investment in research including in strategic areas of relevance to treatment, such as stratified medicine, genomics and biobanking. Develop tests to predict how well patients will respond to therapy options and use imaging to monitor their response, ultimately ensuring each person gets the most effective treatment for them. Ensure patients can access the most appropriate treatments that can offer them the best quality of life, that the UK (and EU) research environment is doing all it can to allow rapid translation of research into clinical practice and that the NHS fulfils its duties to promote and support research. Understand the processes that allow breast cancer to spread to different parts of the body, and those that allow secondary breast cancer to resist treatments. Find the most effective drug combinations and develop new treatments to prevent and control the spread of breast cancer, while making sure that patients quality of life is at the fore. Continue to campaign for reform of the drug appraisal system. And for routine access to the most effective breast cancer treatments, regardless of price, for every woman in every part of the UK. Improve the quality of healthcare and support for secondary breast cancer patients, making sure their needs are met. Continue to work closely with patients and partners across the NHS to improve breast cancer services and make sure that everyone living with breast cancer receives the best possible care and support. 16 Introduction Introduction 17
10 Risk and prevention Risk and prevention Risk and prevention 19
11 Being part of the Generations Study means I m helping Breast Cancer Now find new ways of understanding and preventing the disease. Having watched my beautiful daughter Becs lose her life to this disease, I m determined to do all I can to stop breast cancer. Amanda Jones, Breast Cancer Now supporter 20 Risk and prevention Risk and prevention 21
12 The problem More than 50,000 women and around 350 men are diagnosed with breast cancer every year in the UK. That s around one woman every 10 minutes and one man every day. If we don t act now, by 2030, more than 57,000 UK women will be diagnosed with the disease each year. Research has come a long way in the last two decades. We know more than ever before about what causes breast cancer and we ve started to implement measures and suggest lifestyle changes to reduce the risk of the disease. But we can t yet accurately identify an individual s risk of breast cancer or prevent a significant proportion of cases. We must rise to this challenge and we must do so now. We ve pioneered risk and prevention work across research and embedded it in public health and policy campaigns. Now, by building on these strong foundations, we believe we have the potential to drastically reduce the numbers of women developing breast cancer in the future. Our achievements 1995 We contribute to research linking BRCA2 gene faults with breast cancer The Generations Study launches, one of the world s largest studies into the causes of breast cancer Genetic testing times are reduced to 2-8 weeks following our Testing Times campaign We help identify 49 new inherited genetic variants that affect breast risk, our total is now over We launch BRISK to encourage women to take regular physical activity, proven to reduce the risk of breast cancer, as part of their daily lives We commissioned research worth 1m to improve chemoprevention options for women. 22 Risk and prevention Risk and prevention 23
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14 Early detection and diagnosis Early detection and diagnosis Early detection and diagnosis 27
15 Diagnosing breast cancer early is vital to stopping women dying from the disease. I know I m one of the lucky ones. I also know how important it is that more research is done. I don t want my daughter to worry about whether she ll live to see her children grow up. Carly Gibson, Breast Cancer Now supporter 28 Early detection and diagnosis
16 The problem Diagnosing breast cancer quickly and accurately is vital, as the earlier breast cancer is diagnosed and treated, the greater the chances of survival. Breast awareness and breast screening play fundamental roles in this. As a result of our research, we understand more than ever about the earliest stages of breast cancer and how it develops. Through our pioneering health information and campaigns, we ve worked to turn this knowledge into practical interventions and solutions for women facing the disease. Now, we re working to ensure every woman receives the right diagnosis at the earliest opportunity. Our achievements 2003 Our Left in the Dark campaign drives the landmark two-week wait mandatory target in England TLC Touch Look Check launches Our researchers highlight the need for clear, accurate and consistent information for women with ductal carcinoma in situ (DCIS) Our researchers find that the areas of highest density in some women s breasts indicate where breast cancer is most likely to later be found Our scientists show the molecule αvβ6 could identify which cases of DCIS are likely to progress to invasive cancer A specialised molecule developed by our researchers finds and illuminates HER2 cancer cells using non-invasive scanning. 30 Early detection and diagnosis Early detection and diagnosis 31
17 By understanding the earliest changes in the development of breast cancer, we will make sure women are diagnosed early. Our researchers are investigating the cellular processes that regulate the early development of normal breast tissue to improve our understanding of the initial changes that signal breast cancer. This could lead to new ways to detect the disease. We must ensure the best methods are implemented to detect breast cancer at its earliest stages. A new imaging technique called Digital Breast Tomosynthesis (DBT) acts like a 3D mammogram, and analysis of DBT images could be more effective at showing up areas of high breast density, linked to an increased risk of breast cancer. Our researchers will use DBT to develop a technique to spot areas of high breast density. This could eventually be incorporated into routine breast screening, enabling doctors to spot the signs of breast cancer earlier than is currently possible. Women themselves play a vital part in early detection. We must continue to raise awareness of breast cancer symptoms by working with others to spread our simple TLC Touch Look Check health message. We also need to ensure that the screening programme evolves to incorporate new evidence on the best ways to group people by risk. The ambition Our aim is that increasing numbers of people will be diagnosed early and our improved understanding of different breast cancers will better their chances of successful treatment. By We must continue to raise awareness of breast cancer symptoms by working with others to spread our simple TLC Touch Look Check health message. We believe we will have identified those at increased risk of breast cancer so a further 2,850 women each year will have their disease diagnosed early. And by knowing which breast cancers require treatment and which don t, we aim to eliminate overtreatment, saving over 4,000 women from unnecessary treatment each year. We believe we can reach three quarters of women with our bespoke breast awareness message and increase screening uptake back to its highest ever levels, saving at least 1,500 women s lives each year. 32 Early detection and diagnosis Early detection and diagnosis 33
18 Treatment Treatment Treatment 35
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20 The problem Breast cancer is a complex range of diseases there is no one-size-fits-all approach to overcoming it. And while treatment options have improved rapidly over the last 25 years, there s still much more to be done if we are to provide increasingly tailored treatments that recognise the differences in patients needs. Our research into new treatments has changed the landscape for breast cancer patients. Now, we must develop treatments that are highly targeted and as unique as each individual patient is, ensure all patients can access the right treatment for them and that everyone living with and beyond breast cancer receives the support they need. Making sure the government continues to invest in science and research and that the environment in which research takes place is working as best it can will be critical. To do this, we must ensure the legal framework supports innovations in treatment and that Higher Education delivers the skills and the workforce needed to develop the treatments of tomorrow. Our achievements 1998 We fund the UK s first breast cancer surgical training programme to train the breast surgeons of the future With our funding the largest clinical trial worldwide into Intensity Modulated Radiotherapy (IMRT) for breast cancer launches, and goes on to change radiotherapy practice Our Service Pledge for Breast Cancer launches, delivering service improvements at 64 hospitals to date Our scientists make a major contribution to the development of PARP inhibitors drugs which are now in clinical trials Our scientists develop a simple low-cost test to predict who will benefit from chemotherapy Our Tissue Bank begins making tissue samples and data available to researchers. 38 Treatment Treatment 39
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23 Secondary breast cancer Introduction Secondary breast cancer 45
24 I m doing all I can to keep living with this devastating disease and although there may not be a cure to my cancer at present, with ongoing research developments, I am optimistic about what the future may bring. Rashpal Sidhu Thomson, living with secondary breast cancer 46 Secondary breast cancer Secondary breast cancer 47
25 The problem 1,000 women die from breast cancer each month in the UK. Almost all deaths from breast cancer are caused by the secondary form of the disease, where cancer leaves the breast and spreads to other parts of the body, such as the bones, lungs, liver and brain. It s this process that we need to unpick in order to save lives. Whilst there is no cure for secondary breast cancer yet, we are making real progress in understanding how and why cancer spreads, how it can be treated and what we need to do in order to stop it becoming resistant to treatment. We ve also brought secondary breast cancer out of the shadows, refusing to allow this deadly stage of the disease to be hidden from view in either the research environment or the public arena. Now, we must create an even greater focus on secondary breast cancer, doing more to understand the biology of the disease and how to effectively tackle it, improving treatments and ensuring the needs of those living with it are met. Our achievements 2003 Our researchers reveal the unique physical, emotional and social problems experienced by people living with secondary breast cancer Our research shows blocking the action of the gene Bcl3 stops some breast cancers spreading. A drug targeting Bcl3 is being developed Our researchers identify a genetic switch that makes cancer cells sticky and able to adhere to other parts of the body. Drugs that can interfere with this genetic switch already exist We launch our Demand a Fair Price and Unlock Drugs campaigns and move the issue of drug-pricing and routine access up the political agenda Our scientists reveal the role of a protein called LOX in breast cancer spread to the bone, and that existing drugs could stop this We launch our LEGACY Study for Secondary Breast Cancer, a UK-first study allowing patients to donate their secondary cancer tissues for research. 48 Secondary breast cancer Secondary breast cancer 49
26 We need to understand when and how cancer cells escape and spread to become incurable secondary breast cancer. We need to develop ways to better identify those at risk of their breast cancer spreading. Our researchers are working on techniques that involve looking at tumour DNA found in patients blood to seek early indicators that their cancer is about to spread, so that rapid action might be taken to stop it from happening. We need to understand when and how cancer cells escape and spread to become incurable secondary breast cancer. Research is beginning to reveal that healthy cells throughout the body may be playing an important role in the development and spread of breast cancer. Many of our researchers are now studying these cells, including the cells that line the blood vessels and cells of the immune system, with the hope of finding new treatments that harness these noncancer cells to slow or even prevent the spread of breast cancer. Up to 70 per cent of patients with secondary breast cancer will experience their cancer spreading to the bone. Here it can cause severe pain and fractures. Our researchers are investigating how the bone acts like a soil in which breast cancer cell seeds can grow into a secondary tumour. They are studying a number of proteins that might be acting as a sort of fertiliser. Their ongoing work could lead to new treatments to stop breast cancer spreading to the bone, increasing the chances of survival for thousands of patients. We must also develop new treatments to stop breast cancer spreading and champion clinical trial designs that support their development. We need more research into how novel therapies and combinations of existing drugs affect secondary breast cancer. Our researchers are investigating special cells in the breast tumour called cancer stem cells thought to be responsible for seeding new tumours elsewhere in the body, to figure out how to stop them in their tracks. Tumour and blood samples from women with secondary breast cancer are vital for researchers to be able to understand how secondary breast cancer develops. However these samples are in very short supply. Researchers need to study real samples from patients at every stage of the disease. Working sensitively and collaboratively with consenting patients and their families through our ground-breaking LEGACY Study for Secondary Breast Cancer, we will work to enable secondary tissue to be collected as quickly as possible after a patient dies, and that these samples can be matched with earlier samples taken from these women along with information about the treatments that did and didn t work for them. At a time of unprecedented pressure on the health service and huge scientific advances, it will be more important than ever that everyone affected by breast cancer can access the best possible treatment. Working with the UK Government and the devolved nations, the NHS and industry, we ll campaign for a fair and transparent system for assessing new treatments that ensures patients can access the drugs they need at sustainable prices for the NHS. We will also push for reforms to allow existing, low-cost drugs to be made routinely available on the NHS for new purposes, such as bisphosphonates to prevent breast cancer spreading to the bone, so that all patients can benefit from treatment innovations regardless of where they live and which health professional oversees their care. We will also aim to improve the quality of healthcare for patients with secondary breast cancer by understanding their particular needs and concerns. We must improve our understanding of the number of people living with secondary, and the unique experience they have, to ensure that their different needs are met. It is vital that this patient group is recognised, and that clinical guidance aimed specifically at secondary patients is implemented. The ambition Our aim is to find ways to control and contain secondary breast cancer so we can live with the disease, but never die from it. 20 By By As a result of increased research, we believe 25 per cent fewer people will develop secondary breast cancer. 30 We believe over 50 per cent of those diagnosed with the disease will survive beyond five years. 50 Secondary breast cancer Secondary breast cancer 51
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