OVERVIEW
Statistics*
55,000 people in UK diagnosed each year
1in9women
11,500 women lose their life per year
Just 4% of all cancer funding is spent on prevention
Over 80% of all women diagnosed are over 50 years old
25% of all cases are in women over the age of 75
Breast cancer is the biggest cause of death for women aged 35-49
1 in 10 breast cancers are diagnosed late
Statistics from from Cancer Research UK and The Office of National Statistics
Why Manchester?
Manchester is renowned throughout the global scientific community as leading the world with its research into breast cancer prevention.
Current studies in Greater Manchester include a world first. For the first time anywhere, women are being given a risk assessment at the same time as a breast screening. The result of this study could revolutionise NHS breast screening in the UK.
It is being led by Prevent Breast Cancer, a charity based at Wythenshawe Hospital, that is helping to lead the way towards a new chapter in understanding and preventing this disease. Our scientists are already predicting and preventing breast cancer, helping more people to live a life that is free from the disease. With a world-class research team and the only dedicated prevention centre in the country, we are truly at the front-line in the fight against it. This is our USP – the UK’s only charity solely focussed on preventing breast cancer.
Our work is vital because the rate of breast cancer continues to grow and without interventions the disease will become even more prevalent.
BUT we want to celebrate the ground-breaking work being done in Manchester, and we want to make the city breast aware
Aware of risks
Aware of symptoms
Aware of prediction & prevention
Aware of the struggle and courage of women and their families who are facing breast cancer
This October we are creating BreastFest – a month long campaign of extraordinary stories, events and opportunities.
Manchester, the city that has led the world in so many ways, now will showcase this unique event to women of all ages and ethnicities.
The three groups of women we are targeting
Women 50 plus
Women pre-screening age
Young women – teens and 20s
The messages for our three groups of women
Women 50 plus: Screening saves lives. The NHS screening programme is continually improving and will soon have a smarter targeted approach.
Women 35 to 50: You too can have screening if breast cancer has affected a close family member, or several relatives.
Young women 18 to 35: your lifetime choices can lower your risks. Eat healthily, drink sensibly, stop smoking, avoid junk food and weight gain, exercise regularly. Encourage your mother’s generation and other family members to go for screening.
FOR ALL AGE GROUPS: Breast cancer really can be prevented for future generations if we continue to support our research programme.
Our vision for the future
Women 50 plus
At present the NHS breast screening programme is a one-size-fits-all programme of having a mammogram every three years. This is saving many lives, but not nearly enough. Our vision of the future for this age group is this:
At age 50 every woman in the UK will be invited to:
1. Have a routine mammogram
2. Fill in a questionnaire about their family history, lifestyle and hormone factors 3. Have their breast density measured from the mammogram
4. Have a gene and SNP (gene fragment) test with a mouth swab
Then, these risk factors of family history, lifestyle, hormones, breast density and gene profile are combined to determine the personal risk of developing breast cancer for each woman over the next 10 years. Those at moderate to high risk would be screened every year to 18 months. Those at low or very low risk would not need mammograms at all, and simply be recalled for a further assessment 10 years later. The moderate to high risk women would also be offered preventive tablets and/or lifestyle changes to reduce their risk while they continue to be screened.
WOMEN 35 to 50 YEARS OF AGE
At present many women in this age group who have a mother or sister with breast cancer benefit from annual NHS breast screening check-ups. They may be eligible for NHS gene testing. But many do not come forward, or do not know what is available. So, this age group need to be encouraged to come forward if breast cancer has affected a close relative. But even this is not enough, as most breast cancers in this age group occur in women with NO family history.
Our best advice for women in this age group at present, if they have no family history, is simply to be aware of breast symptoms and changes and report them immediately to their doctor. But this is not enough. Our vision of the future for this age group is this:
At age 35 every woman in the UK will be invited to have a breast cancer risk assessment, where they will: -
1. Fill in a questionnaire about their family history, lifestyle and hormone factors 2. Have their breast density measured on a low dose mammogram or other test 3. Have a gene and SNP (gene fragment) test with a mouth swab
These risk factors will then be combined to pick out women in this age group who may be destined to develop breast cancer in their 30s or 40s. Those at high risk would have annual screening, possibly with mammography but hopefully with better tests that are more effective in this younger age group. They would also be offered preventive tablets (maybe a contraceptive pill that reduced risk rather than increased it) and/or lifestyle changes to reduce risk. Some at highest levels of risk might choose preventive surgery. Those at low risk would not need screening, but they would know the breast symptoms and changes to look out for.
Many women in this age group attend a GP surgery or Breast Clinic with a harmless lump or breast symptom. Our vision is that part of their care should always include having a breast cancer risk assessment done, rather than simply being sent home with reassurance that this lump on this occasion was benign and given no further advice. Then, when they reach 50 years of age a further breast cancer risk assessment would be done at the time of their first regular screening mammogram.
WOMEN 18 to 35 YEARS OF AGE
At present women in this age group can have an NHS gene test if they come from a family where a gene mutation such as BRCA1 or BRCA2 is suspected. Nothing is available for the general population to help prevent breast cancer, despite most breast cancers in this age group being in young women with no family history. Those that do get breast cancer often have a hidden genetic risk that they are not aware of. Our vision of the future for this age group is this:
At age 18 every woman in the UK would be invited to
Have a gene and SNP (gene fragment) test to pick out those with the strongest
genetic risk
Receive information about breast awareness
The gene and SNP test should pick out those young women with the highest levels of risk of developing breast cancer even before 35 years of age. This group would include those with a strong family history, those with no family history, and those who are adopted or don’t know their family history for other reasons. Mammography is not very effective in this age group, and we still need to develop better tests. Those at highest risk might consider preventive surgery, or preventive tablets, or lifestyle changes. Ultimately, we want to develop preventive strategies that mean surgery will become a thing of the past.
For those at low levels of risk, the likelihood of breast cancer is so low that nothing else need be done until these women reach 35 years of age when they can have a formal breast cancer risk assessment done (as described above for that age group).
TIMESCALES:
WOMEN 50 plus: 2 to 5 years.
We are currently running a pilot study of risk assessment and “targeted screening” for this age group in Manchester to assess feasibility and affordability. If successful, targeted screening can then be recommended for the whole of the UK.
WOMEN 35 to 50 YEARS OF AGE: 5 to 10 years.
We still need further research into improved screening scans, breast density, and potential preventive drugs and pills before we will know exactly how to make this work effectively. In the meantime, this age group still need better awareness of what is currently available for those with breast cancer in the family. The NHS will provide gene tests and regular screening for those with a mother or sister with breast cancer at a young age, or more than one close relative. Awareness of breast symptoms and changes that need checking is also important.
WOMEN 18 to 35 YEARS OF AGE: 10 years.
It will take a few more years before gene testing is sufficiently accurate, affordable and practical to offer to the whole female population. We also need better preventive drugs as an alternative to surgery, and improved screening scans. In the meantime, the NHS will provide gene tests for those from families where BRCA1 or BRCA2 genes are suspected. However regular screening with scans is currently not possible. Awareness of breast symptoms and changes that need checking are also important.
TO MAKE OUR VISION A REALITY:
Our vision for each group is based on the results of our research so far. Our current research programme is testing these possibilities further. But to really prevent breast cancer we still need more improvements in predicting risk, screening and early diagnosis, and preventive drugs and strategies. The goal of breast cancer prevention is achievable. The way forward is to continue this exciting research programme.
Click here for a definition of high-risk genes and SNPs.
What are our Goals for BreastFest?
We want to: -
Make women breast aware and equip them with the knowledge to understand: -the different risk factors (those you can and can’t control)
the symptoms of breast cancerGive women the confidence to speak to their GPs and ask for a referral to a breast unit, should they find a symptom or have a concern
Educate women about the importance of breast screening – increase uptake
Fundraise for Prevent Breast Cancer, the only charity in the UK focused entirely on
prevention, so that they can continue their research.
Below is more detailed information to support the 4 Goals
OUR GOALS
Make women breast aware and equip them with the knowledge to understand risk factors and symptoms.
Understanding Risk
It’s important that women of all ages understand the different risk factors - some you can control whilst others you cannot. Below are the main risk factors
Risk Factors women can control - 25% of breast cancer diagnoses are preventableOverweight/ Obesity
High Alcohol intake
Lack of exercise
Hormones – contraceptive pill and HRT
Risk Factors women cannot control
Age – the biggest risk factor – over 80% diagnoses over 50Age at first period
Age at first pregnancy and number of pregnancies
Age at menopause
Whether you breast fed (dependent on age could still be controlled)
Breast density
Family History
Previous breast lumps
What is breast density, and can women do anything about it?
Women with high breast density can be six times more likely to develop breast cancer than women of the same age with low breast density. This density is nothing to do with the softness or firmness of how a breast feels, but rather how dense it looks on a mammogram. Density can be measured by the whiteness shown on a mammogram (% of glandular tissue compared to fatty tissue).
At present the NHS does not provide any extra screening for women with high breast density; but Prevent Breast Cancer is working to change this. We are researching how to target extra screening for the over 50s with a high risk of breast cancer, due in part to high density. We are also researching how to calculate risk for the 35 to 50 age range based on breast density and working out strategies for screening and prevention methods to lower risk.
Our research now shows that breast cancer is not random and that women, and men, who develop the disease are genetically predisposed. This predisposition combined with lifestyle, environmental and hormonal factors can trigger breast cancer.
Our researchers aim to find out why some women have denser breast tissue and why denser breasts are more likely to develop cancer. To watch a simple explanation of breast density
Six Steps women can take
STEP 1
BE BREAST AWARE
easier to spot any unusual changes. Learn how to check your breasts and make sure you’re familiar with how they normally look and feel. Click here for more information. Breasts can change at different times of the month, so it’s important to work out what’s normal for you and if you have any concerns speak to your GP and asked to be referred to a breast unit e.g. The Nightingale Centre.
If you’re aged between 47 and 73, take advantage of the breast screening you will be offered in the form of regular mammograms.
STEP 2
MAINTAIN A HEALTHY WEIGHT AND LIFESTYLE
Our research has found that having a Body Mass Index (BMI) of between 18 and 25 lowers your risk of breast cancer. If you’re already overweight, losing just 5% of your weight (and keeping it off!) can reduce your risk substantially - by between 25 and 40%. Eat more fruit, vegetables and wholegrains while avoiding processed foods which are often high in sugar and fat.
Smoking is of course bad news for our health. Around half of smokers die prematurely
from smoking related cancer, heart disease, stroke or other conditions. Smoking gives a small increase in risk of breast cancer, particularly for those women with a family history and there is evidence that shows an increased risk for women who started smoking before the age of 17. Whilst smoking is relatively low down in the list of risk factors for breast cancer, our advice of course is DO NOT SMOKE.
STEP 3
BE PHYSICALLY ACTIVE
Aim for five exercise sessions a week, lasting 35 to 45 minutes each. Our research has found that as well as reducing the risk of developing breast cancer, exercise can lower the risk of the disease coming back (recurrence) if you’ve already been diagnosed.
STEP 4
DRINK ALCOHOL SENSIBLY!
Alcohol increases the risk of breast cancer. If you choose to drink, you can help keep your risk of developing breast cancer from alcohol low by limiting your intake to 14 units a week. The more you cut down on alcohol, the more you reduce your risk. Spread your drinks evenly throughout the week. If you’d like to cut down, try having several drink-free days each week.
STEP 5
HORMONES
Research has found a link between the oestrogen hormone and breast cancer. Aim to stop using oral contraceptives when you’re around 30 – speak to your GP about the alternatives available to you.
Breast feeding can help lower your risk of breast cancer and we recommend that if possible, you breastfeed your baby for at least six months.
Limit the use of Hormone Replacement Therapy (HRT) to a short time and avoid using this continuously for years.
STEP 6
GENE TESTING
If several of your family members have had breast or ovarian cancer, or your mother or sister was diagnosed with the disease before the age of 50, you may want to discuss gene testingwith your GP.
It’s important that you undergo proper counselling before making any decisions about being tested. Should you carry the gene that increases breast cancer risk, it’s likely that you’ll be offered a range of preventative options going forward, including regular screening.
Give women the confidence to speak to their GPs
If you notice a breast symptom of change, the first step is to visit your GP who then has access to NHS Breast Clinics across the UK who work to a “2-week rule” to see you within 2 weeks of being referred. Your GP can also refer you to a family history clinic if breast cancer is in your family, for example if your mother or sister was diagnosed at a young age.
Educate women about the importance of breast screening – increase uptake
About the NHS Breast Screening Programme
The NHS breast screening programme starts at 50 (in some areas 47) and women are invited to screening every 3 years until the age of 70 (in some areas 73). If a woman over the age of 70 wishes to attend screening are encouraged to call their screening unit and arrange an appointment.
Why is screening not offered to younger women? As outlined above the biggest risk factor (if there is no family history) is age. However, we know that breast cancer is the biggest cause of death for women aged 35-49, so what’s the answer?
Is screening harmful?
While mammograms do use X-rays, the risk of triggering a breast cancer is very small at around a 1 in 10,000 chance. So, unless you are planning to have thousands of mammograms please don't worry!
The issue and screening statistics
Not all women are attending their breast screening appointments, yet screening saves lives as it can detect pre-cancer changes and early stages of breast cancer.
Every woman in the 35 to 50 age group with breast cancer in the family should
consider this and they should discuss the issue with their GP and asked to be referred to one
of the many family history clinics across the UK. The vision of Prevent Breast Cancer is gene
testing for everyone, but this will require a few more years of research to make it possible.
Very early breast cancers are usually easier to treat, may need less treatment, and are more likely to be cured.
breast cancer by 1,300 per year and more than 18,001 breast cancers are diagnosed in
England through screening per year.
Almost all women diagnosed with breast cancer at the earliest possible stage survive for at
least 5 years after diagnosis and are likely to be cured.
The Greater Manchester breast screening programme invites approximately 65,000 women per year to screening.
Coverage
Defined as the % of women in the population who are eligible for screening at a specific point in time and have had a test result recorded in the last three years. The acceptable level for coverage is 70%.
Figures for 2017-2018
In England coverage fell to 74.9%, a decrease from 75.4% in 2016-2017
Coverage in the North West was 72.8%
o 62%inManchestero 68%inSalford
Uptake
Defined as the % of women invited for screening in the year, who were screened adequately within six months of invitation.
Figures for 2017-2018
In England uptake fell to 70.5% from 71.1% in 2016-2017
Uptake in the North West was 69.8%
o 66.5%inGreaterManchester, 67%inEastLancashire
The above statistics have been published by NHS Digital - https://digital.nhs.uk/data-and- information/publications/statistical/breast-screening-programme/england-2017-18
A 2016 inquiry into geographical inequalities was published by the All-Party Parliamentary Group on Breast Cancer and it highlighted hat several CCGs in the North West were below average, including: -
• Manchester Central – 59.1%• South Manchester- 56.8%
• North Manchester – 58.3%The same report also highlighted premature deaths from breast cancer in women under the age of 75. The national average was 19.8%: -
• Manchester Central – 22.3%• South Manchester- 21.8%
• North Manchester – 21.2%Click HERE for link to APPG report -
WE NEED TO GET MORE WOMEN TO ATTEND THEIR SCREENING
Fundraise for Prevent Breast Cancer’s research
Smarter Screening – our research to revolutionise the breast screening programme
Our charity’s ground-breaking PROCAS research (Predicting Risk of Cancer at Screening) predicts each individual woman’s risk of cancer at the time of screening, with our scientists assessing a series of factors in addition to the mammogram, such as breast density, family history and lifestyle. Through this analysis they generate a “risk score” for developing the disease, and once they know their score, women are able to make pro-active choices about their health.
Almost 19,000 women across Greater Manchester, Cheshire and Lancashire will take part in our study, which means large numbers will be benefitting from our highly effective new methods. 1,500 of these women will also be offered a DNA saliva test, which will enable our scientists to incorporate DNA gene fragment analysis (SNPs) into the risk assessment.
The trials are due to complete in 2020.
Once we know which women are at a high risk of breast cancer, we can offer a number of
strategies to reduce risk or even prevent the disease.
Regular screening for which we require improved technologies (over conventional mammography and MR scanning).
Lowering of lifestyle risk by interventions that are acceptable and effective; such as dietary, exercise and hormone-based interventions.
“Switching off” genetic factors – through research into drugs, vaccines and antibodies, which interfere with biological pathways.
Our goal is that by 2022 this new approach will be rolled out across the UK and we believe it will have a significant impact on preventing breast cancer. But we require more funds to continue our research. For more information about the future of our research, please refer to “Our Vision for the Future”.
Ways to raise funds and awareness through BreastFest and Boo-Bee
100 Women – 100 stories
Corporate support – sponsorship, employee engagement
BreastFest week
Planned activity to date: -
Turn/ Paint Manchester Pink
VIP Event in October
Afternoon tea for 1,000 - 5th October 2019
Boo-Bee Bus
Elements to be included in the campaign: -
Scientific research explained / facts & information relating to various elements of risk
Supporting and empowering women and their families who have experienced the
disease
Fundraising via events & corporate relationships
Overview of other research findings and areas of interest
HIGH RISK GENES
In a small number of women, breast cancer may be caused by a mutation in a gene such as BRCA1 or BRCA2. Our research is improving our understanding of how these genes work, with the longer term aim of developing drugs that can switch off their harmful effects. Gene testing is now more widely available, enabling more people than ever to take preventative action to protect themselves against breast cancer.
SNPS (‘SNIPS’)
Most women who get breast cancer have no family history of the disease. Research suggests that in the 85% of women with no family history at all, there may nevertheless be an underlying genetic predisposition caused by tiny faults or variations in genetic makeup known as ‘SNPs’ (gene fragments). Women who carry several such SNPs have a much higher chance of breast cancer than those who carry none. Now we have the ability to identify those women at risk, we can offer them a range of preventative options.
PREVENTION THROUGH PREDICTION
Testing for high risk genes and SNPs is one way of predicting risk. Another way is to an analyse family history and lifestyle factors. Another is the mammographic density of breast tissue. In the future we may be able to combine these techniques to predict risk; then offer intensive screening to some, while others can relax knowing that they have a very low risk.
BETTER MAMMOGRAM TESTS
Regular mammograms save lives, but sometimes the mammogram is unable to spot cancer changes. We are working out ways to improve the accuracy of these tests. New technology and computer analysis will improve and then replace current mammograms with better technique
DUCTAL CARCINOMA IN SITU (DCIS)
Breast cancers go through a preliminary early cancer stage known as DCIS. We are conducting research into how to diagnose and treat DCIS at an early stage to prevent it progressing into cancer. It may be possible to switch off the genetic or cell malfunctions, for example by using new preventative drugs or other simple interventions.
ENVIRONMENTAL FACTORS
Our research confirms that healthy breast tissue can contain many artificial chemicals. None of these have been shown to be a direct cause of breast cancer, and in particular there does not seem to be a link with deodorants. Processed foods seem to be a higher risk. We think this is because of their high calorie content rather than specific chemicals and additives in the foods. More research will be undertaken in this area to identify environmental factors that increase the risk of breast cancer, enabling people to reduce their exposure to these.
BREAST CANCER PREVENTION DIET
Prevent Breast Cancer’s Dr Michelle Harvie is the only UK dietician working solely in the field of breast cancer research, specialising in strategies to prevent the disease and its recurrence. Alongside Professor Tony Howell, award winning Dr Harvie is co-author of the bestselling 2-Day Diet, which helps people to reach a healthy weight and reduce breast cancer risk. It involves following a low-carbohydrate diet for two days a week and eating normally but sensibly for the rest of the week.
WHY WE SAY 1 IN 9 WOMEN
1 in 10 is the lifetime risk for the average woman in the UK (median average); but this figure is 1 in 8 if you include women who have a BRCA gene (mean average). We use 1 in 9 as we believe this is a true reflection, needless to say too many women are being diagnosed.