With 10-year survival rates now exceeding 80% , the effects of surgery on a woman’s self-image are a major factor in her emotional and psychological recovery. The tools developed by the three-year, EU-funded PICTURE (Patient Information Combined for the Assessment of Specific Surgical Outcomes in Breast Cancer) project aim to help patients be a more informed part of the therapy decision process, thus feeling more in control of their treatment, while providing reassurance and improving visual results.
Breast cancer is the most common cancer in women in Europe. It is usually treated with surgery, often in conjunction with radiotherapy and systemic treatments. Two types of surgery are available: breast-conserving surgery (also known as lumpectomy) or mastectomy. However, even breast-conserving surgery can affect how the breast looks, a prospect that causes many women a great deal of stress. Consequently, a good aesthetic outcome is an important consideration in breast cancer therapies and is closely linked to the patient’s psychological recovery and self-image after treatment. Yet for an estimated 30% of women treated with breast-conserving surgery, the result is less than ideal aesthetically .
“Breast cancer is an increasingly treatable disease. Many women will live for many years with the consequences of their therapy. Any changes to how their breast looks can have a huge impact on how they feel about themselves and how they live their lives. Breast cancer therapies have now developed to the point where doctors, surgeons and patients must come together to consider these factors as part of a shared decision making process on treatment options. But to date there is no objective way to assess the aesthetic outcome of breast cancer treatment.”, said Prof Maria João Cardoso, MD, PhD, from INESC (PT) and Head Breast Surgeon at the Breast Unit of the Champalimaud Foundation in Lisbon (PT).
“We are hopeful that the demonstrator from the PICTURE project may go a long way in empowering our patients and support personalising care in breast cancer. It also has the potential to assist clinicians in objective decision making and assessment of the aesthetic outcome after treatment”, said Dr. Mohammed Keshtgar MD, PhD, Consultant Surgical Oncologist from UCL (UK) and the Royal Free London NHS Foundation Trust.
The PICTURE project aims to address these issues. This collaboration plans to develop a prototype of a tool that could predict how an individual patient’s breast will look after breast-conserving surgery. Besides reassuring patients about the long-term cosmetic effects of surgery, the tool could be used to assess the different outcomes of different therapy options. This could then be important input for conversations between clinicians and patients about which treatment option is most suitable for that patient – both clinically and aesthetically. Moreover, it has the potential to help surgeons optimise aspects of the surgery (such as the size and location of the incision) to minimise changes in how the breast looks.
To do this, the PICTURE consortium plans to develop biomechanical modeling techniques that use 3D photography and standard diagnostic scans (such as mammograms, ultrasound and MRI) to create a digital representation of the anatomy of the breast. The goal is that this digital model will allow the aesthetic effects of treatment to be predicted and visualised. Once developed, the prototype tool will be validated using data from volunteer patients who have already been through therapy.
“Philips aims to transform healthcare through meaningful, patient-centric innovation which helps to improve people’s lives. Through PICTURE, we are combining our expertise in oncology as well as image processing and medical imaging with the clinical and academic strength of our partners. The technologies developed in PICTURE could support oncologists and surgeons in their efforts to make breast cancer therapy an even more human-focused process that includes patients and their preferences from the very beginning of their treatment.” said Dr. Jörg Sabczynski, Senior Scientist at Philips Research and coordinator of the PICTURE project.
The three-year PICTURE project will run until January 2016, receiving €2.15 million funding from the European Community’s Seventh Framework Programme under grant agreement No. FP7-600948.
About the PICTURE consortium
• Philips Technologie GmbH Innovative Technologies, Research Laboratories, Germany
• Instituto de Engenharia de Sistemas e Computadores do Porto (INESC Porto), Portugal
• University College London, UK
• University Medical Center Leiden, Netherlands
• King’s College London, UK
 J. Ferlay, E. Steliarova-Foucher, J. Lortet-Tieulent, S. Rosso, J.W.W. Coebergh, H. Comber, D. Forman, F. Bray: “Cancer incidence and mortality patterns in Europe: Estimates for 40 countries in 2012”, European Journal of Cancer (2013) 49, 1374– 1403.
 C. E. Hill-Kayser, C. Vachani, M. K. Hampshire, G. A. Di Lullo, and J. M. Metz, “Cosmetic Outcomes and Complications Reported by Patients Having Undergone Breast-Conserving Treatment”, International Journal of Radiation Oncology Biology Physics (2012) 83, 839-844.
INESC TEC – INESC Technology and Science
INESC Technology and Science – INESC TEC is an Associate Laboratory coordinated by INESC Porto that brings together 770 researchers, of which close to 230 have PhDs. INESC TEC incorporates 13 Units with complementary skills that form a robust centre of scientific and technological development in Portugal with notable international presence.