"Internal wiring" of cancer predicts risk of relapse



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Breast Cancer Awareness Activists

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Researchers say that "internal cabling" of breast cancer can predict which women are most likely to survive or relapse.

The study shows that breast cancer is 11 distinct diseases, each with a different risk of recurrence.

The hope is that the results, in the journal Nature, can identify people who need closer monitoring and reassure others at low risk of recurrence.

Cancer Research UK said the work was "incredibly encouraging" but was not yet ready for widespread use.

Scientists at Cambridge University and Stanford University have examined in detail nearly 2,000 breast cancers in women.

They went well beyond the simple consideration of all breast cancers and how modern medicine classified tumors.

Doctors are currently classifying breast cancers based on their response to estrogen hormone or targeted treatments like Herceptin.

The research team analyzed genetic mutations inside the tumor to create a new way of classifying them.

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Legend

Breast cancer is not a disease but 11, say the researchers.

Earlier work by the group has shown that breast cancer is composed of 11 distinct diseases, each with a different cause and requiring different treatment.

By following women for 20 years, they are now able to show which types of breast cancer are most likely to reappear.

Professor Carlos Caldas of the BBC: "It's really biology, it's the molecular cabling of your tumor.

"Once and for all, we must stop talking about breast cancer as a single disease, it's a constellation of eleven diseases.

"This is a very important step towards more precision medicines."

Change of treatment

It turns out that triple negative breast cancers – one of the most difficult types to treat – were not all but one class of cancer.

Prof. Caldas said: "A case where women who have not re-offended before five are probably cured, but a second subgroup is still at high risk of relapse."

Research could help inform women of their future risks, but could also change the way their cancers are treated.

There were four subgroups of breast cancer that were both estrogen-induced and had a "significantly increased" risk of recurrence.

These women may benefit from longer treatment of hormonal drugs like tamoxifen.

Cancer Research UK estimates that 12,300 women a year suffer from this type of cancer in the United Kingdom.


Analysis

By James Gallagher, Health and Science Correspondent, BBC News

Cancers tend to be named after where they are: breast, colon, prostate, lung – the list is long.

But we have known for a long time that this is not enough.

This study shows the future of personalized medicine and the adaptation of treatments to the specific causes of cancer.

Studies are already underway to determine the most effective treatments for different subtypes of breast cancer.

And other research groups are trying to get similar insights on other forms of cancer.

  • New era of personalized anti-cancer drugs

However, the way scientists have analyzed and sorted cancers is still too complicated to be introduced into the NHS.

It will need to be refined in a form that could be used routinely to analyze a woman's cancer.

Much larger studies involving up to 12,000 women are also planned, so that researchers can be certain of their results.

Professor Caldas said, "I would not recommend it clinically yet, but we are really determined to make it available.

"We are totally committed to doing an NHS test, we have not patented anything."

Prof. Karen Vousden, chief scientist at Cancer Research UK, said: "We are still unable to offer this type of detailed molecular testing to all women and we need more research to understand how to adapt treatments to the patient's individual tumor. " biology.

"But it's incredibly encouraging progress."

Follow James on Twitter.

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