Envisioning breast cancer prevention in the future
Breast cancer – the most common cancer among women – affects 2.1 million women around the globe each year. It also causes the greatest number of deaths compared to other forms of the disease. Over the years, scientists have made great advances in identifying genetic risk variants and developing tools for measuring individual risk. However, there isn’t an overall vision of how these advances can be used to personalise future prevention methods and how personalised prevention could take place through particular healthcare mechanisms. Researchers participating in the EU-funded B-CAST project sought to address this problem in a multidisciplinary workshop held in 2018. According to the workshop report published in May 2019, likely future scientific and technological advances were explored in terms of their ability to shape personalised prevention methods in the future. Developments in breast cancer prevention Different experts presented their views on anticipated future developments and their potential use in breast cancer prevention. Overall, scientific and technological advances are expected to bring about great changes in personalised prevention of breast cancer. For example, biomarkers can be used to provide answers relating to disease prediction, diagnosis, choice of therapy and the likelihood the cancer will recur. While applying current biomarker knowledge in healthcare settings has its challenges, emerging knowledge could be used to improve prevention pathways. Furthermore, developments in biosensors are making it possible to detect a wider range of biomarkers. Wearable sensors and apps were acknowledged as being able to help manage modifiable risk factors, however their quality, safety and effectiveness needs to improve before they can be widely adopted in healthcare. Enormous amounts of data are becoming increasingly available through advances in artificial intelligence, wearable sensors and other digital technologies. Nevertheless, it’s believed that clinical interpretation of outputs will always be needed to ensure their validity and usefulness. A vision of personalised prevention in the future The workshop participants agreed that population-wide and risk-based preventative methods are needed to prevent breast cancer. They highlighted the significance of promotional and educational messages as a means to support specific personalised or individual risk efforts. The following risk groups were identified as important: women with a high risk of developing likely fatal breast cancer, women with genetic predisposition and women at low risk who likely won’t benefit from mammographic screening. Currently, risk-based prevention of breast cancer within the general population isn’t possible due to the lack of fully validated tools. However, the participants envision that this will be possible in the next 20 years when tools are developed that will be able to identify women most likely to die from breast cancer. Some practical changes were recommended to make widespread risk-based care a reality. First, healthcare professionals need to be able to understand and communicate risk information. Second, individuals need to be given support – ranging from lifestyle changes to specific treatments – tailored to their personal risk. Last, an infrastructure must be developed for the collection, collation and analysis of risk factor data. The conclusions reached from the B-CAST (Breast CAncer STratification: understanding the determinants of risk and prognosis of molecular subtypes) workshop will inform the project’s future work. Following a further policy analysis, B-CAST intends to prepare a final report on integrating personalised prevention methods into wider prevention programmes aimed at public health professionals and policymakers. For more information, please see: B-CAST project website
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