Rethinking breast cancer research and funding

David Cameron

BIG Chair, Professor of Oncology and Clinical Director, Edinburgh Cancer Research Centre

As knowledge about breast cancer and its various subtypes grows, we need to rethink established research and funding models to ensure progress continues.

Over the past 40 years, thanks to advances in treatment, teamworking in the delivery of treatment, and technology, breast cancer survival rates have doubled in the UK and most Western countries. The recognition that breast cancer is not a single disease, but rather multiple diseases, has been key in driving progress.

We need to go global to find enough patients for research

“If you want to pick up a group of patients with an uncommon subtype, then you will not find enough in any one country to do a study in a meaningful length of time,” explains Dr David Cameron, Chair of Breast International Group (BIG) and Professor of Oncology and Clinical Director of the Edinburgh Cancer Research Centre.

BIG, an international not-for-profit organisation that represents the largest global network of academic research groups dedicated to finding cures for breast cancer, is looking to overcome this challenge by working with over 55 like-minded research groups tied to several thousand specialised hospitals, research centres and world-class breast cancer experts across the world. Through this collaborative approach, BIG aims not only to increase the pool of patients, but also tap into global medical expertise.

“Over the years there has been increasing alignment in the way that different countries treat breast cancer, which is helping to smooth the pathway to greater collaboration,” says Cameron.

Financial viability

Of course, patient numbers aren’t the only figures that need to be balanced. Pharmaceutical companies often fund trials but, as Cameron observes, “there is no commercial incentive for a company to develop a drug for a very small group of patients with a rare cancer subtype. Equally, there is no return on clinical trials for drugs that are already out of patent.”

The recognition that breast cancer is not a single disease, but rather multiple diseases, has been key in driving progress.

“We’ve got a study going on (called POSITIVE, also known as BIG Time for Baby) to see whether you can stop your breast cancer treatment to get pregnant. It’s a critically important question – but such studies aren’t commercially viable,” continues Cameron. “That’s why we need more academic research and we need more funding models to answer these questions.”

BIG has also just finalised enrolling 1,000 patients into a research programme that will study the evolution of metastatic breast cancer (called AURORA, or BIG Metastatic Breast Cancer GPS). The knowledge gained will provide a bedrock of data that will hopefully inform diagnosis and treatment.

Patient voices are vital in effecting change

Patient care can’t be compromised and it’s vital that patients contribute at every stage of clinical trials, from planning to completion. Patient advocates will play a key role in events taking place as part of Pink October – a month dedicated to raising awareness of breast cancer – where the theme of de-escalation of treatment will feature highly.

As we learn more about the genomics of breast cancers and the way they behave, treatments are becoming more targeted. Patients can achieve the same or even better outcomes while being spared some of the aggressive chemotherapy or radiotherapy options and the unpleasant side effects that they cause.

This is good news for patients. However, more than 600,000 individuals worldwide (source: GLOBOCAN 2018) continue to lose their lives to the disease each year. There is still much left to learn, and research and trials are key to supporting the millions of women, and men, affected by breast cancer.

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About 95% of BIG’s revenue is spent directly on research conducted under the BIG umbrella. Donate at www.BIGagainstbreastcancer.org/donate