10:05pm Thursday 19 October 2017

New guidelines recommend women with rare aggressive breast cancer should be offered less invasive surgery

Women with a rare type of breast cancer should be offered less invasive surgery where appropriate, according to new guidelines presented on Friday (24th April 2015) at the Inflammatory Breast Cancer Symposium in Birmingham, UK.

Inflammatory breast cancer (IBC) is a rare sub-type of the disease with poor survival rates that is thought to affect up to 1,000 women in the UK each year. It gets its name from the red and swollen appearance of the breast’s skin.

In this particularly aggressive and rapidly appearing type of cancer, the lymph drainage system within the breast, which usually drains away waste products from cells, can be disrupted by tumour cells.  As the lymph vessels become blocked, the drainage fluid (known as lymph) builds up causing swelling and redness.  

Whilst previous guidelines recommended that a mastectomy was always required for inflammatory breast cancer patients, these new UK-led clinical recommendations encourage a localised, breast-conserving approach where possible.
 
Providing that the cancer has not spread and that the cells surrounding the tumour, taken out during surgery, are confirmed as non-cancerous (known as “clear margins”), there is no evidence to show that breast conservation surgery is any less safe than a mastectomy for this group of patients.

These new guidelines, published in the British Journal of Cancer1, also represent the first time that a group of UK clinicians and researchers have agreed a specific definition of inflammatory breast cancer. It is hoped that this will offer much-needed clarity to clinicians and patients alike, reducing possible delays in reaching a diagnosis at what is already a difficult and distressing time for patients.

Experts believe that the establishment of clear national guidelines for IBC will better standardise both diagnostic and treatment decisions. The knock-on effect of this, according to the group behind the guidelines, will be a better environment in the UK for collecting standardised information and tissue samples from IBC patients, fostering vital research interest and progression in this under-researched area.

Other recommendations for best practice proposed in the guidelines include the routine use of skin biopsies to identify the presence of dermal Lymphovascular invasion, using clinical photography to capture more detail in diagnostic descriptions of breast appearance; using a combination of mammography and ultrasound as minimum requirements in breast imaging and an endorsement of the combination of chemotherapy and Herceptin with another biological therapy such as pertuzumab (Perjeta), where available, for use in treatment of HER-2 positive IBC.

The guidelines, presented at Friday’s Symposium, were formulated and presented by the UK Inflammatory Breast Cancer Working Group following a series of workshops, sponsored by leading research charity Breast Cancer Campaign and Breakthrough Breast Cancer.

Dr Daniel Rea, Reader and Consultant in Medical Oncology at the School of Cancer Sciences, University of Birmingham and UK Inflammatory Breast Cancer Working Group clinical lead, commented:

“These new guidelines represent a real step forward not only for clinicians but, more importantly, for women with inflammatory breast cancer in the UK.

“Treatment options that specifically target this rare breast cancer do not exist, and we need a concerted research effort to fix that. These new recommendations will allow some inflammatory breast cancer patients to be spared a more invasive mastectomy, and as treatments improve we hope that a breast conservation approach will become increasingly common.”

Baroness Delyth Morgan, Chief Executive at Breast Cancer Campaign and Breakthrough Breast Cancer, said:

“These desperately-needed guidelines will mean a better future for women with inflammatory breast cancer. With up to 1,000 women diagnosed with the disease in the UK each year, many of whom could be spared more gruelling surgery, the needs in this critically under-researched area must be met. Collecting tissue samples from women with IBC into our Tissue Bank will allow researchers around the world to help more women outlive this aggressive disease sooner.

“These new guidelines represent the fruit of collaborative research that we are very proud to support. We look forward to further work in this area that will give women with inflammatory breast cancer new options.”

 

Dr Fedor Berditchevski, Group Leader at the School of Cancer Sciences, University of Birmingham and UK Inflammatory Breast Cancer Working Group academic lead, said:

“We hope publication of these guidelines will be a trigger, building much-needed momentum for academic and translational research into inflammatory breast cancer in the UK. It’s only through the coordinated and concerted efforts of scientists and clinicians from various disciplines in this area that we will be able to better understand the biology of this condition and ultimately save the lives of more women.”

 

ENDS

 

1. Rea, D. et al (2015) ‘Inflammatory breast cancer: Time to standardise diagnosis assessment and management, and for the joining of forces to facilitate effective research’, British Journal of Cancer DOI: 10.1038/bjc.2015.115.

The new recommended guidelines on inflammatory breast cancer have been published in:

Rea, D., Francis, A., Hanby, A., Speirs, V., Rakha, E., Shaaban, A., Chan, S., Vinnicombe, S., Ellis, I., Martin, S., Jones, L. and Berditchevski, F. (2015) ‘Inflammatory breast cancer: Time to standardise diagnosis assessment and management, and for the joining of forces to facilitate effective research’, British Journal of Cancer DOI: 10.1038/bjc.2015.115.

 

For further information, to arrange an interview with Dr Daniel Rea or Dr Fedor Berditchevski, or for any case study requests, please contact:
Jamie Lederhose at Breast Cancer Campaign and Breakthrough Breast Cancer on jlederhose@breastcancercampaign.org or 020 7749 0897

Notes to Editors:

Breast Cancer Campaign and Breakthrough Breast Cancer have joined forces in 2015 to become the UK’s largest breast cancer charity. United, we will achieve our shared ambition that by 2050 no one will die from breast cancer.

For more than 25 years Breakthrough Breast Cancer and Breast Cancer Campaign have funded cutting-edge research with an aim to preventing breast cancer, detecting it early, and treating it as effectively as possible. Together, we are determined to end breast cancer, once and for all.

Funding for the Inflammatory Breast Cancer Symposium comes from The Breast Cancer Campaign Tissue Bank, made possible by its founding partners Asda’s Tickled Pink and Walk the Walk.

We have a proud history of ground-breaking research:

The Breakthrough Generations Study – set up in 2004 – is world’s largest and most comprehensive study into the causes of breast cancer and is following more than 113,000 women throughout their lives.

The Breast Cancer Campaign Tissue Bank, the UK’s first ever national breast cancer tissue bank, is a unique collaboration with five leading research institutions to create a vital resource of breast cancer tissue for researchers across the UK and Ireland.

Breast cancer is not yesterday’s problem; it remains the most common cancer in the UK and accounts for nearly one in three of all cancers in women. In the UK, over 50,000 new cases of breast cancer are diagnosed each year – that’s 138 a day.


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