The incidence of breast cancer is expected to double by 2040. This is attributable to increased detection, women living longer, and the fact that our western lifestyle predisposes us to this condition which affects 3,000 women and 20 men in Ireland annually.
It is the commonest cancer in women in this country and the commonest cause of death in middle aged women.
Approximately one in 400 women over 50 years are diagnosed annually with the disease, according to Professor Michael Kerin, the professor of surgery at NUI Galway and the director of breast cancer research at the Lambe Institute for Translational Research at NUI Galway.
The breast cancer team at the cancer centre in Galway treat 600 new cases of the condition each year.
Breast cancer gets commoner as people get older and many women in their 80s and 90s present with the disease. Usually the condition is very treatable in older women.
There has been significant development in the treatment of breast cancer, outlines Professor Kerin. “There has been a dramatic change. The single biggest factor is the individualisation of treatment. When I started in the 1980s nearly every patient had a mastectomy. Now surgery is less radical and lumpectomies and more conservative treatments are the norm. More than 70 per cent of patients have breast conservation.
“With regards to chemotherapy, the approach 10 years ago was fairly blunderbuss. We now understand the sub types of breast cancer, for example, the luminal group is strongly hormonal sensitive, a large proportion of people with this type - 60 per cent - will not require chemotherapy if detected early.”
Better drugs are used these days to fight the condition and to prevent relapses. “Herceptin, for example, will halve the risk of relapse. There is a vogue towards more targeted therapy too, anti-hormonal treatment has a better menu of endocrine therapy than a decade ago.”
Early detection of breast cancer means those affected have more treatment options available to them and a better chance of survival. More than 80 per cent of people who get the condition are cured. The goal of the national breast cancer screening programme BreastCheck is to identify breast abnormalities as early as possible.
Professor Kerin believes the “entire population” needs to be educated about the value of screening which is available free to women aged 50 to 70 every two years. “The compliance rate is 70 per cent which is not bad by international standards. But in order to be successful the closer it is to full screening the better.”
There is a reduced uptake of the screening offer among people from lower socio economic groups. He says the controversy over the CervicalCheck screening programme did not help either.
Huge shock
Being diagnosed with breast cancer is a “huge shock to the system” for people, he says. “What we try to do is explain what is involved in an open and honest way and they get to understand the management plan. A multi disciplinary team is involved in this. The treatment is very individualised. We try to provide support to help people through the treatment.”
He says in the context of development programmes and improved outcomes one of the best research questions that can be answered is why individual patients relapse. “Here at the Lambe Institute at UHG (a unique centre where near patient research occurs ) we concentrate on biomarkers, assessment, novel methods of earlier diagnosis, and the identification of new genes that cause breast cancer as well as improved therapies, including breast reconstruction.
“The best way to find out why people relapse is to look at the individual tumour at the time of presentation [and if a secondary develops] and see if we can predict what was happening. We have a big programme looking at biomarkers, these give information on what kind of tumour it is, what treatment will work, and the relapse rate.
“We are looking at MicroRNA - tiny fragments of Professor Michael Kerin information in the bloodstream - which gives information on relapse risk and breast cancer type. With patients’ permission we take tissue and blood from them at presentation and look at these. We have published widely [on this area].”
One of the institute’s major research programmes is focused on breast regeneration. “This involves using [a patient’s own] fat cells to hopefully regrow the breast in people who have had a mastectomy. We are one of the few centres in the world working on this. It will take five to 10 years. This would have a huge advantage in terms of reducing the burden of surgery.
“Other exciting areas involve looking at Microwave Imaging to see if it can detect breast cancer when used either in conjunction with mammography or potentially instead of it. Mammography is the current gold standard but it has some drawbacks - it won’t pick up all breast cancers, it is not as effective in younger women, and involves compression of the breast which some find intolerable.”
Some 30 per cent of women still require mastectomy as part of their treatment, according to Professor Kerin.
“About 60 to 70 per cent having mastectomies have immediate reconstruction today. There is a huge advantage in this psychologically because patients are coping with the physical and emotional loss of a breast. However, this obviously involves a more complex operation.”
Reconstruction may feature implants or the “Rolls Royce” of reconstruction, a DIEP flap. “This operation involves moving the abdominal fat pad onto the chest wall. This [reconstructed breast] tends to have the same texture as the original breast and should be able to gain or lose volume in the same way. This is a big operation and is not suitable for everyone, you could not do it on someone who is very thin or is smoking.”
As part of this new October Festival and with it being Breast Cancer Awareness month, Galway Races are partnering with the National Breast Cancer Research Institute to host a dedicated fundraiser for the organization on Sunday October 28 called ‘Race in Pink’. The National Breast Cancer Research Institute is an Irish charity that raises funds in support of the breast cancer research team lead by Professor Michael Kerin based at the Lambe Institute, NUI Galway.
