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The ATAC trial was conceived, designed and implemented by UCL investigators, and has resulted in a dramatic, global change in the management of breast cancer. It directly compared tamoxifen, the standard treatment for breast cancer for 25 years, with anastrozole, a novel aromatase inhibitor. It convincingly demonstrated superiority for the new agent, in terms of both progression-free survival and adverse effect profile. Tamoxifen had been the world's most widely prescribed anti-cancer drug but was supplanted by anastrozole as a consequence of this trial.
Laboratory research at Imperial College supported the concept of switching adjuvant treatment of breast cancer (i.e. tamoxifen for 2-3 years to exemestane for 2-3 years) which has now been shown in Imperial-led clinical trials to improve overall survival of breast cancer patients for at least 5 years post-switching. In association with this, the effects of switching on endometrial, skeletal and joint function have shown few long-term deleterious effects. This way of treating breast cancer has now gained acceptance worldwide, as being more efficacious and resulting in fewer longterm, serious side effects. It is the recommended treatment in international guidelines.
Research from UCL Division of Surgery has transformed the breast cancer treatment paradigm so women can complete their local treatment intraoperatively (~30 min), with reduced toxicity. Our work has challenged the dogma of giving several weeks of whole breast radiotherapy (EBRT) after lumpectomy for breast cancer with our idea of irradiating only the tumour bed in selected cases; we have developed and evaluated new technology called TARGeted Intraoperative radioTherapy (TARGIT) within the novel approach of risk-adapted radiotherapy. To date, TARGIT has saved 180,000 hospital visits and could save £60M(UK)/ $280M(USA)/year.
Basic, clinical and applied research at the University of Cambridge has culminated in a widely-used risk prediction algorithm ("BOADICEA") for familial breast and ovarian cancer. This web-based, user-friendly tool predicts the likelihood of carrying mutations in breast and ovarian cancer high risk genes (BRCA1 and BRCA2), and the risk of developing breast or ovarian cancer. In 2006, BOADICEA was been recommended by the UK National Institutes of Health and Clinical Excellence (NICE: CG41, 2006) and the American Cancer Society (since 2011). In June 2013, NICE recommended BOADICEA in subsequent guidance (CG164). Furthermore, several national bodies have designated BOADICEA as the standard tool to assess eligibility for high risk breast cancer screening.
Researchers at the University of Manchester (UoM) have made a significant impact internationally on improving outcomes for women diagnosed with breast cancer (>49,000 pa in the UK) and on preventing the disease. The changes in clinical practice based on our research are now national guidelines and have helped set international treatment standards. These new approaches have: increased the duration of survival of women with advanced breast cancer; reduced relapse rates and improved survival after surgery for early breast cancer; and prevented disease in women at high risk. The revised treatment has benefited >1.5m women worldwide annually who develop breast cancer and sales of anastrozole, which has replaced tamoxifen as the major endocrine therapy, have grossed over $1bn p.a.
Aromatase inhibitors (AIs) significantly improve survival from breast cancer but are associated with increases in osteoporotic fractures and bone mineral density loss. Research at the University of Manchester (UoM) has provided key evidence that has contributed to preventing debilitating bone demineralisation safely in breast cancer patients undergoing adjuvant therapy with AIs. UoM findings have led to an international consensus on guidelines recommending Dual-energy X-ray Absorptiometry (DEXA) scanning to identify patients at risk of bone loss as well as the use of bisphosphonates where bone loss has been identified. Further guidelines advise against the use of HRT to treat bone loss as a result of its association with breast cancer recurrence.
Basic and applied research at the University of Cambridge has culminated in a widely-used risk prediction algorithm ("BOADICEA") for familial breast and ovarian cancer. This user-friendly web-based tool predicts the likelihood of carrying mutations in breast and ovarian cancer high-risk genes (BRCA1 and BRCA2), and the risks of developing breast or ovarian cancer. BOADICEA has been adopted by several national bodies including NICE in the UK (2006 until present), the American Cancer Society and the Ontario Breast Screening Program (both since 2011) for identifying women who would benefit from BRCA1/2 mutation screening, intensified breast cancer screening and chemoprevention.
Research on the relationship between women's working lives, occupational exposures and breast cancer, which uses detailed work histories as a means of identifying toxic exposures, has found there to be an elevated risk for women working in agriculture, bars and gambling environments, as well as automotive plastics manufacturing, food canning, and metalworking workplaces. The influential study has led trade unions, politicians and charities in the United Kingdom and Canada to demand health and safety regulatory changes and further research.
A number of studies have been produced by the multidisciplinary, multinational team, in which Professor Matthias Beck plays a lead role. The main study was published and released to the media in 2012 (Brophy et al. 2012b); so far it has attracted more than 16,000 downloads and over 220 media references.
The primary treatment for ductal carcinoma in situ (DCIS, cancer confined to the milk ducts of the breast) is surgery, and breast-conserving surgery is increasingly preferred over mastectomy. The UK/ANZ DCIS trial, co-led by Queen Mary researchers, showed that following surgery, women with DCIS are significantly less likely to develop invasive disease if given radiotherapy, and that this protection persists long term. NICE recommends that, following adequate breast conserving surgery, adjuvant radiotherapy should be offered to patients with DCIS. This recommendation is also current in the United States, Canada, Australia, and many European countries. Based on current figures, we estimate that in UK alone, around 260 women each year are spared a recurrence of breast cancer as a result of this research.
As a result of research at Queen Mary, an estimated 2,500-3,000 additional women per year in UK have a breast cancer detected early through two-view mammography at the NHS Breast Screening Programme, and similar country-wide benefits have occurred abroad. From 1988 the NHS Breast Screening Programme offered women aged 50-64 three-yearly one-view mammography. In 1995, results from the UKCCCR Randomised Trial of One and Two View Mammography (led by Queen Mary researchers) showed that including a second view increased breast cancer detection by 24% and reduced recall rate by 15%. On the basis of this evidence, the Department of Health immediately issued an Executive Letter requiring all breast screening units to move to two-view mammography for the prevalent screen. Changes were rapidly and widely implemented. By 2004, two-view mammography had become the policy at all screens, prevalent and incident. Two-view mammography remains national policy and its benefits continue to the present day.