October 2009 podcast transcript

00:00

Kat: Welcome to this special Cancer Research UK podcast for Breast Cancer Awareness. We'll be finding out how the latest advances in research are leading to new treatments, and hear how one doctor spotted her own breast cancer on a mammogram.

 

Breast cancer is the most common cancer in the UK, and the latest figures show that over 45,500 women a year are diagnosed with the disease – around 125 a day. And around 300 men were also diagnosed with the disease.

The good news is that there are more than half a million women alive today who are surviving breast cancer, but thousands of women still lose their lives to the disease every year.

Cancer Research UK is the major funder of breast cancer research in the UK. Our work covers all aspects of research into the disease, from prevention to diagnosis, and from understanding the fundamental biology of breast cancer to developing better treatments.

01:17

Many breast cancers are discovered by women themselves, but what's the best way to check yourself? Here's Jean Slocombe, one of Cancer Research UK's cancer information nurses, to give us the low-down on what to look for

"Many women know that a breast lump needs to be checked out by a doctor as it could be a sign of cancer, but of course many breast lumps aren't cancer. But there are other things women need to be aware of – it's all about breast awareness, knowing what your breasts looks like what they feel like, and reporting changes to your doctor.

You're looking for a lump or any thickening, but you also want to be aware of the skin of your breasts – are there any red or sore patches? Is the skin dimpled or puckered? Has the nipple position changed? Anything like that, a rash around the nipple, that needs to be looked at as well. It probably isn't cancer but it must be checked out.

I don't think we need to be prescriptive about it – we used to say "Oh you should check your breasts once a month" but just pick a time that fits in with your lifestyle, maybe once a month or once every few weeks when you're in the shower. Probably don't check your breasts just before a period, because they can feel a little lumpy then, but after a period is a good time.

It's very important to attend breast screening when you're invited to. Women from age 50 are invited to go for breast cancer screening every three years in the UK, and breast cancer screening saves lives, so it's important that when you get your appointment, please go. If the appointment doesn't suit you, if it's a time you don't like you can always change it. I've just been for mine recently and it didn't take very long once I was there. You're in and out in a few minutes and the people there are very professional and they treat you very well.

If you find something that you don't think is normal for you, it's important to go to your GP. Your GP can possibly reassure you that it's nothing to worry about, or they can send you to the breast clinic for further investigations. Most breast problems are not cancer, but please get them checked out without delay because early treatment saves lives."

03:31

Kat:Women are invited to come for screening from the age of 50 until 70, but women over 70 can always phone up to ask for an appointment at their local screening centre. And women with a strong family history of breast cancer may be invited for screening from a younger age.

Dr Sarah Burnett knew that her family history put her at increased risk of breast cancer, and her job as a radiologist meant that it was easy for her to get screened. But it was still a shock when she spotted something suspicious on the film.

I met Sarah at a rather noisy train station, and asked her to share her story.

"My mother had breast cancer when she was fifty so I was screened from quite an early age. I'm a radiologist, which means that I'm a doctor specialising in imaging, so it was very easy for me to go in and say to the technical staff "Can I get a mammogram done?" so I've been screened from thirty-eight.

In October 2004 I had some microcalcification, which is basically little chalky spots on the breast, and they'd changed, so I had some biopsies done. But they were all completely normal. So I went for my routine mammograms a year later, completely confident they were going to be normal, and I looked at the films and I thought "Ah, gosh, there's a little spot there that wasn't there last year."

I'm not a breast specialist, so I had to wait to see one of the breast specialist radiologists, and he was scanning me with ultrasound, and they found eleven tumours in total. So within the week I had a mastectomy and a reconstruction. I went on to have chemotherapy over about 6 months, and that's nearly two years ago now, and I'm delighted to say that I'm fit and well.

When I first looked at the film I probably used language that you can't use in your podcast! Admittedly I'm in a funny position because most patients wouldn't be looking at their films themselves.

I think to a certain extent, looking at the films over the years I'd always thought the right breast was an accident waiting to happen, so I wasn't that shocked. What I was shocked was to find out that it was multi-focal disease – lots of tumours. That did come as a very unpleasant surprise.

It has had a positive and negative impact on my life. I was going through a very difficult phase with my boyfriend at the time of diagnosis, and in fact it has brought us together – I know that sounds like a real cliché. But we have a fantastic relationship now. The kids have got through it – both of them have best friends with mums who have breast cancer, so it's becoming an all-too-familiar scenario.

I still get tired, I think that takes quite a long time to get over. But you modify your life. I was an absolute workaholic beforehand, and I've really now found the opportunity to say to myself "No, don't do that Sarah, spend a bit of time with the boyfriend or the kids, or the dogs."

Since my mother was diagnosed I'd always raised money for Cancer Research UK. I did the Race for Life for many years and in fact the first year my daughter ran it she was four and she was the youngest runner in the whole country. So it's something that's always been part of what I do anyway. But now, obviously, it's even more important. If it wasn't for organisations like Cancer Research UK, I wouldn't be here to do it."

06:50

Kat: Professor Charles Coombes leads the Department of Oncology at Imperial College London, and is head of the Cancer Research UK labs there.

He is one of the UK's leading breast cancer scientists, and made a significant contribution to the development of hormone-blocking aromatase inhibitors, important weapons in our fight against breast cancer.

I spoke to Professor Coombes, to find out how hormones are involved in breast cancer, and how he and his team are developing new treatments for the disease.

"Hormones – mainly oestrogen – drives breast cancer cells to divide, so it acts as a kind of fertiliser for breast cancer cells. Tamoxifen has been the standard way that people have tried to block oestrogen action, because Tamoxifen is an anti-oestrogen – it prevents oestrogen from gaining access to the cells to cause the cells to divide. The problem is that more than half of breast cancers eventually become insensitive to Tamoxifen.

So the first drug that we developed was a drug that would work after Tamoxifen has exerted its action and worked. And that class of drugs is called aromatase inhibitors, including drugs such as Arimidex, exemestane, letrozole – they're all inhibitors of oestrogen synthesis.

Under those circumstances what happens is a cancer cell becomes resistant to Tamoxifen by over-expressing [over-producing] the oestrogen receptor, and the way to make those cancer cells die is to withdraw oestrogen completely. If you withdrew oestrogen after Tamoxifen treatment, you could get a lot of cancer cells to die, that had become resistant to Tamoxifen.

So what we've been trying to understand is why do breast cancer cells become resistant to aromatase inhibitors? This has been the next big challenge. And after about 15 years of work, we now think that we understand the mechanism. What happens is that various other signalling pathways in the breast cancer cell impinge on the oestrogen receptor, so it increases its sensitivity [to oestrogen].

Aromatase inhibitors, although they stop the body from making oestrogen and lower the oestrogen very significantly, often by as much as 99 per cent, they don't actually reduce it by 100 per cent. But this low level of persistent oestrogen can be ‘amplified' by various other enzymes, which can be used to target in breast cancer.

Once enzyme that we recently discovered that does this is called CDK7, and we now over the last two years have developed a specific inhibitor for CDK7, which prevents the activation of the oestrogen receptor. That drug is now being optimised and will be, we hope, available for women whose cancer cells have become resistant to aromatase inhibitors.

Another route that we have gone down, and which has already produced a drug which is being tested throughout Europe, is in looking for other sources of this residual tiny percentage of oestrogen that remains after aromatase inhibitors have been used.

It turns out that breast cancer cells can bypass the aromatase pathway by using a storage form of oestrogen, called oestrogen sulphate. And there's an enzyme called oestrogen sulphatase that cleaves the sulphate off, liberating the oestrogen. So it's a very clever way that breast cancer cells use this enzyme to liberate oestrogen which can then sit on the receptor, even when aromatase inhibitors are being used, and drive the cells to divide.

It's taken about 15 or twenty years work, mainly by chemists and other Cancer Research UK-supported scientists, at Bath University and at Imperial College. They have made the first inhibitor of this enzyme – there hasn't been an inhibitor to date – but this new drug has now been tested by our group here and has been found to completely abolish the enzyme activity, and this is the drug that's in trials in patients whose breast cancers have become resistant to aromatase inhibitors."

Kat: If you want to find out more about any aspect of breast cancer, from signs and symptoms to treatments and the latest research, then have a look at our patient information website, CancerHelp UK. It's www.cancerhelp.org.uk

And if you want to raise money for our vital research towards beating breast cancer, then there's loads of things you can do. Whether it's hosting a pink party, doing a sponsored walk or anything else you can imagine, find out how you can get involved at www.cancerresearchuk.org/breastcancer You can also call our fundraising hotline on 08701 60 20 40.

12:46

We've reached the end once more so we hope you've enjoyed this month's podcast. You can keep up to date with all the latest progress in research from our Science Update blog.

And please let us know what you think of this podcast by leaving feedback on the blog, or emailing your comments to podcast@cancer.org.uk.

We'll be back next month with a roundup of the NCRI Cancer Conference – the UK's largest meeting dedicated to cancer research and cancer care, taking place in Birmingham at the beginning of October. So until then, goodbye!

 

  • Credits:
  • Presented and produced by Kat Arney
  • Original music written and performed by Kat Arney and Henry Scowcroft
  • With special thanks to all the participants