It may be a cliché, but most cancer researchers would accept that prevention is better than cure. That was certainly the strongly shared belief at a debate at the National Cancer Research Institute conference about ways of reducing the incidence of breast cancer.
However, like most destinations, there are many ways of getting there – the challenge is in convincing those you’re travelling with that your way is best.
The event, hosted by Breast Cancer Now and presented by Professor Robert Coleman, pitted two teams of experts against each other in a debate over the motion: This house believes we should stop focusing on the causes of breast cancer and get on with strategies to prevent the disease.
A poll before the event showed an audience evenly divided between those ‘for’ and those ‘against’ – setting the scene for a lively and engaging debate.
The first team to throw down the gloves – comprising Professor Annie Anderson and Professor Gareth Evans – argued for the motion and in favour of focusing on interventions to prevent the disease.
Providing context for their argument, the team pointed to the rising incidence of breast cancer in the UK – up 70% since the 1970s. Key to their case was that 1.68 million women a year are diagnosed worldwide – evidence for the need for impactful strategies on a global scale.
They argued that, despite up to 30% of breast cancers in women with moderate to high risk being preventable through lifestyle modification – particularly through reducing obesity and alcohol consumption – research into behavioural interventions to mitigate these risks was not currently prioritised.
They pointed out that while lots of money is spent on breast cancer research, only 2-3% goes on preventative measures. A sound evidence base is needed for policy makers to fund pubic health initiatives. By continuing to focus research on the causes of breast cancer – they argued – we are simply fishing for risk factors of decreasing effect sizes. Instead we needed to change the paradigm and focus our research endeavours on what we already know.
The argument was rebutted by the formidable Oxbridge team of Professor Doug Easton and Professor Tim Key, defending the need to focus research on the causes of breast cancer.
They argued that the risk attributable to lifestyle factors such as obesity was not large enough to make breast cancer a rare disease, even if all the breast cancers caused by these factors were successfully prevented. By settling with our current knowledge of risk factors we will never reach Breast Cancer Now’s vision of no breast cancer deaths by 2050.
The professors pointed to the fact that our current understanding of genetics only accounts for half of the heritable risks for breast cancer. They argued that emerging avenues of research into genome sequencing, tumour sequencing, subtype analysis, imaging, genetic predictors of exposure and epidemiology show promise and should not be ignored. They urged the audience to take a long-term view and pointed to the discovery of the BRCA genes and subsequent approval – 20 years later - of drugs to target genetic mutations in them.
A highly engaged audience challenged the panel on topics including compliance with chemopreventive medicines, research into repurposing of drugs, the affordability of new medicines, and the role of the food industry in promoting healthy eating.
A second poll of the audience, after the closing arguments, showed a slight shift in favour of those ‘for’ the motion to start focusing on prevention strategies. The motion carried – albeit only just – but the debate will continue as passionately as ever.
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