Critical research gaps and translational priorities for the successful prevention and treatment of breast cancer.
Eccles SA., Aboagye EO., Ali S., Anderson AS., Armes J., Berditchevski F., Blaydes JP., Brennan K., Brown NJ., Bryant HE., Bundred NJ., Burchell JM., Campbell AM., Carroll JS., Clarke RB., Coles CE., Cook GJ., Cox A., Curtin NJ., Dekker LV., Silva IDOSS., Duffy SW., Easton DF., Eccles DM., Edwards DR., Edwards J., Evans D., Fenlon DF., Flanagan JM., Foster C., Gallagher WM., Garcia-Closas M., Gee JM., Gescher AJ., Goh V., Groves AM., Harvey AJ., Harvie M., Hennessy BT., Hiscox S., Holen I., Howell SJ., Howell A., Hubbard G., Hulbert-Williams N., Hunter MS., Jasani B., Jones LJ., Key TJ., Kirwan CC., Kong A., Kunkler IH., Langdon SP., Leach MO., Mann DJ., Marshall JF., Martin L., Martin SG., Macdougall JE., Miles DW., Miller WR., Morris JR., Moss SM., Mullan P., Natrajan R., O'Connor JP., O'Connor R., Palmieri C., Pharoah PD., Rakha EA., Reed E., Robinson SP., Sahai E., Saxton JM., Schmid P., Smalley MJ., Speirs V., Stein R., Stingl J., Streuli CH., Tutt AN., Velikova G., Walker RA., Watson CJ., Williams KJ., Young LS., Thompson AM.
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.