Critical research gaps and translational priorities for the successful prevention and treatment of breast cancer

Suzanne Eccles, Eric Aboagye, Simak Ali, Annie Anderson, Jo Armes, Fedor Berditchevski, Jeremy Blaydes, Keith Brennan, Nicola J. Brown, Helen Bryant, Nigel Bundred, Joy Burchell, Anna Campbell, Jason Carroll, Robert Clarke, Charlotte Coles, Gary Cook, Angela Cox, Nicola Curtin, Lodewijk DekkerIsabel dos Santos Silva, Stephen Duffy, Douglas Easton, Diana Eccles, Dylan Edwards, Joanne Edwards, D. Evans, Deborah Fenlon, James Flanagan, Claire Foster, William Gallagher, Montserrat Garcia-Closas, Julia Gee, Andy Gescher, Vicky Goh, Ashley Groves, Amanda Harvey, Michelle Harvie, Bryan Hennessy, Stephen Hiscox, Ingunn Holen, Sacha Howell, Anthony Howell, Gill Hubbard, Nick Hulbert-Williams, Myra Hunter, Bharat Jasani, Louise Jones, Timothy Key, Cliona Kirwan, Anthony Kong, Ian Kunkler, Simon Langdon, Martin Leach, David Mann, John Marshall, Lesley Martin, Stewart Martin, Jennifer Macdougall, David Miles, William Miller, Joanna Morris, Sue Moss, Paul Mullan, Rachel Natrajan, James O'Connor, Rosemary O'Connor, Carlo Palmieri, Paul Pharoah, Emad Rakha, Elizabeth Reed, Simon Robinson, Erik Sahai, John Saxton, Peter Schmid, Matthew Smalley, Valerie Speirs, Robert Stein, John Stingl, Charles Streuli, Andrew Tutt, Galina Velikova, Rosemary Walker, Christine Watson, Kaye Williams, Leonie Young, Alastair M. Thompson

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INTRODUCTION Breast cancer remains a significant scientific, clinical and societal challenge. This gap analysis has reviewed and critically assessed enduring issues and new challenges emerging from recent research, and proposes strategies for translating solutions into practice. METHODS More than 100 internationally recognised specialist breast cancer scientists, clinicians and healthcare professionals collaborated to address nine thematic areas: genetics, epigenetics and epidemiology; molecular pathology and cell biology; hormonal influences and endocrine therapy; imaging, detection and screening; current/novel therapies and biomarkers; drug resistance; metastasis, angiogenesis, circulating tumour cells, cancer 'stem' cells; risk and prevention; living with and managing breast cancer and its treatment. The groups developed summary papers through an iterative process which, following further appraisal from experts and patients, were melded into this summary account. RESULTS The 10 major gaps identified were: (1) understanding the functions and contextual interactions of genetic and epigenetic changes in normal breast development and during malignant transformation; (2) how to implement sustainable lifestyle changes (diet, exercise and weight) and chemopreventive strategies; (3) the need for tailored screening approaches including clinically actionable tests; (4) enhancing knowledge of molecular drivers behind breast cancer subtypes, progression and metastasis; (5) understanding the molecular mechanisms of tumour heterogeneity, dormancy, de novo or acquired resistance and how to target key nodes in these dynamic processes; (6) developing validated markers for chemosensitivity and radiosensitivity; (7) understanding the optimal duration, sequencing and rational combinations of treatment for improved personalised therapy; (8) validating multimodality imaging biomarkers for minimally invasive diagnosis and monitoring of responses in primary and metastatic disease; (9) developing interventions and support to improve the survivorship experience; (10) a continuing need for clinical material for translational research derived from normal breast, blood, primary, relapsed, metastatic and drug-resistant cancers with expert bioinformatics support to maximise its utility. The proposed infrastructural enablers include enhanced resources to support clinically relevant in vitro and in vivo tumour models; improved access to appropriate, fully annotated clinical samples; extended biomarker discovery, validation and standardisation; and facilitated cross-discipline working. CONCLUSIONS With resources to conduct further high-quality targeted research focusing on the gaps identified, increased knowledge translating into improved clinical care should be achievable within five years.
Original languageEnglish
Pages (from-to)R92
JournalBreast cancer research : BCR
Issue number5
Publication statusPublished - 1 Oct 2013


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