Breast cancer is the most common form of cancer amongst woman, and one of the leading causes of cancer deaths in women; however, breast cancer can also occur in men. Breast cancer rates are much higher in developed nations compared to developing ones and is more common in elderly women; women in more developed countries live much longer than those in the poorer nations. It is believed that the different lifestyles and eating habits of females in developed countries are also a contributing factors.
The anatomy of a female breast
A mature human female’s breast consists of fat, connective tissue and thousands of lobules – tiny glands which produce milk. The milk of a breastfeeding mother goes through tiny ducts (tubes) and is delivered through the nipple.
The breast, like any other part of the body, consists of billions of microscopic cells. These cells multiply in an orderly fashion – new cells are made to replace the ones that died.
In cancer, the cells multiply uncontrollably, and there are too many cells, progressively more and more than there should be.
Cancer that begins in the lactiferous duct (milk duct), known as ductal carcinoma, is the most common type. Cancer that begins in the lobules, known as lobular carcinoma, is much less common.
What has emerged in recent years is that breast cancer is a heterogeneous group of diseases each characterised by factors that predict outcome, so called prognostic factors e.g. the size of the tumour and whether the cancer has spread to the lymph glands. There are also factors that predict response to treatment e.g. the presence of oestrogen and progesterone receptors as well as the human epithelial receptors. Where predictive factors to response are present, they guide the choice of therapy as they can reliably predict response to that particular treatment. Unfortunately, there are cancers that have no factors that predict response to available therapies and have been given the very non-descript name of triple negative breast cancers. The dilemma with this group of breast cancers is the lack of a reliable predictors of response to treatment. Some respond to conventional chemotherapy and others don’t. They do not respond to endocrine deprivation and neither to Trastuzumab- the drug that targets the Her2 receptor (human epidermal growth factor receptor 2) found on some breast cancers that confers an aggressive behaviour.
Breast cancers can occur in families, often with a clear genetic link, the so called BrCa mutations, and in others no recognised genetic mutation. BrCa mutant breast cancers usually offer a strong family history and usually arise in younger patients. They are also often triple negative tumours. The BrCa gene is thought to affect the repair process in the genes effected by chemotherapy and by so doing affect its ability to destroy the cancer cell.
A drug has been developed to reverse this process rendering chemotherapy more effective and forms the basis of one of our ongoing trials.
Entry into this trial requires the patient to have the BrCa gene as well as locally advanced or metastatic breast cancer. Genetic counselling is offered to all patients who are potential candidates for the study before a blood test is performed to determine the BrCa status. The implications of having a BrCa tumour are wide spread as female members of the family may also harbour the gene and will be managed accordingly.
Suitable candidates then have the extent of disease assessed as part of a staging of disease process before being randomised to one of 2 arms of treatment. At present, chemotherapy is the standard of care and so one group of patients get chemotherapy alone the second get chemotherapy with the trial drug. The question we are trying to answer is, “Can we improve on the standard of care in BrCa breast cancer.”
If you feel you fit the above criteria and would like to discuss your possible inclusion in this trial feel free to contact our research department to set up an appointment.