BREAST NEOPLASM: TAKING STOCK OF DIAGNOSIS AND PREVENTION
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Q&A with Professor Janssens
President of the European Cancer Prevention Organisation, in Hasselt, Belgium
Editor of European Journal of Cancer Prevention
By Andrea Massa
Prevention in oncology was often considered secondary until quite recently. What led to this shift and how has it affected the general clinical approach?
Treatment of cancer is often mutilating and toxic, and above all not able to cure all patients. To reduce mortality and mutilation as much as possible, prevention is the next step to go. If we consider for example that almost 90 % of lung cancers are from smoking, cessation of smoking would decrease mortality up to 85%.
This year will mark the end of a decade in which breast cancer remains the most lethal form of cancer for women. What have we achieved in terms of prevention and the ability to predict who is at risk of developing it?
Mortality from cancer in women was mainly from breast cancer indeed, but is now replaced by lung cancer mortality. The decrease in breast cancer mortality has been mainly achieved by earlier detection through innovations in mammography, ultrasound, and tissue acquisition. Another important issue is women’s awareness. If they feel or see an abnormality, most women will seek immediate help. In addition, women at risk have been better identified by genetic testing, type of mammogram (dense breasts), and appropriately treated with hormonal medication.
Breast cancer has been linked to wealthy socioeconomic status, affecting foremost the USA and Western Europe. Unfortunately, the threat is on the rise in the developing world. How are those countries dealing with it and what can they learn from us about overcoming it?
Indeed, developing countries adopt Western lifestyles and at the same time adopt increased risk for some cancers, including breast cancer. These countries, like China for instance, are aware of this and now have regular meetings where they invite Western scientists to deal with the subject and learn from it. Major screening programs are in the pipe-line for breast and colon cancer.
Breast cancer is said to originate almost entirely at puberty, with an unbalanced diet and lack of physical activity among the strongest risk factors. Is changing lifestyles a key to cancer control?
Changing the lifestyle of children will have an effect on growth characteristics (for example menarche) and secondary on breast cancer risk. The main factors are related to being overweight, secondary sex characteristics, nutrition, and physical activity.
Genes also play an important role in the development of cancer. How is gene-based research contributing to prevention? Do high costs make it prohibitive?
Genes play an important role in about 5 per cent of the most prevalent cancers. Gene-based research can identify groups of individuals that can be counseled for prevention. The cost of genetic testing for preventive purposes is much lower than that of cancer treatments.
In terms of diagnostics, do the risks and benefits of mammography still justify the effort and costs of this kind of screening?
The number of lives saved and the reduction in mutilating therapies outweighs the costs and limitations of mammography. However, when mammography is promptly available in most Western countries (reimbursed) the net effect of screening is less obvious. In countries where no regular reimbursement is available, free screening mammography is slowly adopted by the women community but effect is clearly seen.
Some costs related to the implementation of successful diagnostics, like digitalization and biopsy, can often become an issue for public finances. Does funding remain the ultimate challenge? Have Western European governments and the private sector made any progress in this field?
Hesitation about funding new medical technologies is justified since medical device companies can bring a lucrative business in preventions while the financial resources are limited. It is the duty of the industry to provide the medical community with less expensive but even more effective and safer tools.
Several studies are evaluating low cost approaches that can be used and sustained in low-resource settings. Does current technology offer any other less expensive but reliable method of cancer detection?
If low cost of the product, in addition to efficacy and safety, is an issue for the industry, the free market will have to give attention to this criterion. For example, in macrobiopsy the trend was to have high-end products for high prices. Now some companies provide even better tools for a fraction of the traditional prices.
Does thermography, for instance, allow a valid option for the early detection of a breast tumor?
Although a splendid idea, thermography has not entered clinical routine due to the many artifacts that need to be considered.
Finally, what’s your point of view on chemoprevention to reduce the risk of a neoplasy?
Every means of prevention should be considered, even chemoprevention. In particular when changing life-style, nutrition, physical activity etc. are not sufficient, individuals like to consider alternatives.
Are there any breakthroughs on the horizon of breast cancer prevention?
Measuring breast density is a surrogate marker of breast cancer risk in a stage where real prevention (reversing the process of carcinogenesis) is still possible. In the next years we will see a shift of screening towards very early reversible lesions to prevent not only mortality, but also mutilating interventions and psychological stress.
European Journal of Cancer Prevention
The European Journal of Cancer Prevention emphasizes the rapid publication of important research into fundamental aspects of cancer prevention, making it essential reading for researchers in a wide variety of fields. The scope is wide ranging, including descriptive and metabolic epidemiology, histopathology, lifestyle issues, environment, genetics, biochemistry, molecular biology, microbiology, clinical medicine, intervention trials and public education, basic laboratory studies and special group studies. . Learn more
Visit the journal website: www.eurjcancerprev.com