More than 100 advocates from most of EUROPA DONNA – The European Breast Cancer Coalition’s 47 member countries were in Amsterdam for the 10th European Breast Cancer Conference (EBCC10) to learn about the latest scientific findings in breast cancer, progress with European policy on implementing breast services, and to present the patient's perspective. EUROPA DONNA is a co-organiser of EBCC in equal partnership with the European Organisation for Research and Treatment of Cancer (EORTC) and the European Society of Breast Cancer Specialists (EUSOMA). This year's scientific programme was divided into the steps of the patient journey.

EUROPA DONNA President and conference co-chair Roswitha Britz presented the EBCC Arts and Humanities Prize to the Norwegian Breast Cancer Society and the Norwegian Cancer Society for their film “To Mommy”, about a 27 year old mother living with advanced breast cancer. This echoes the Coalition’s commitment to increasing awareness of the needs of women with metastatic breast cancer, as well as those of younger women.

View the film

One of EUROPA DONNA's other main advocacy objectives is to see the implementation ofspecialist breast units that meet European quality standards, a demand which was included in the first EBCC Statement issued in 1998. EBCC10 continued to highlight this important goal by presenting its European Breast Cancer Science Award to Past President of EUSOMA Luigi Cataliotti for his achievements in setting out the requirements for specialist breast units that are included in the European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis and in creating a breast unit accreditation system. In his acceptance speech, Prof Cataliotti acknowledged the hard work and dedication of EUROPA DONNA in advancing specialist breast unit implementation and accreditation through advocacy at the European Parliament and in its member countries. EBCC10's Statement or Manifesto is also dedicated to this aim.

The 2016 deadline for all patients in the European Union to have access to specialist breast units adhering to quality standards has not been met in most countries. This deadline was set in two European Parliament Resolutions and two Written Declarations on breast cancer. In direct response to this, the EBCC10 Manifesto calls on policymakers and politicians to ensure that, as soon as possible, all women and men with breast cancer in Europe are treated in a specialist multidisciplinary breast unit and that these units meet the quality requirements of a European accreditation scheme. It also calls for the promotion and acknowledgement of the evidence that multidisciplinary breast units deliver superior care to women and men with breast cancer. This Manifesto was prepared by a European Breast Cancer Council working group whose members include ED Executive Director Susan Knox. Roswitha Britz told conference attendees: "We will use the Manifesto on implementation of specialist breast units in all of our advocacy activities – we commit to holding a meeting with MEPs to ensure their ongoing commitment to it and to secure their help to get it implemented."

Read the Manifesto

This important session for EUROPA DONNA outlined the European Commission Initiative on Breast Cancer (ECIBC) which involves creating a pilot, voluntary quality assurance scheme for breast cancer services and a new edition of the European Guidelines on screening and diagnosis. Donata Lerda of the Joint Research Centre, which is in charge of scientifically and technically implementing the plan for DG SANTÉ explained that a web hub will host all the elements of the programme. The scheme is to be ready for feedback, piloting and reviewing in 2018. Chris de Wolf, chair of the guidelines committee, described the complex process of formulating the new edition of the guidelines, to be called "European Breast Guidelines".  Robert Mansel, chair of the Quality Assurance Scheme Development Group (QASDG), said that their aim is to create a quality assurance programme that can be used by all and monitored by individual countries. He said that the hope is that it will be the "bible of how to use a breast cancer service". In presentations on the patient's perspective, ED CEO Susan Knox described her role on the Guideline Development Group and ED Deputy CEO Karen Benn described her work on the QASDG. Susan Knox emphasised the importance of Member States being involved throughout the development process so that the scheme can be rolled out immediately upon its completion, "EUROPA DONNA has already dedicated 15 years to working on achieving quality assurance for the women of Europe, so we are looking forward to the execution of ECIBC."

ECIBC web hub

Annie Anderson of the United Kingdom presented World Cancer Research Fund data indicating that 38% of postmenopausal breast cancer could be avoided through lifestyle measures such as maintaining a healthy weight, being physically active and restricting alcohol intake. She cited studies showing the benefit of giving women lifestyle advice during mammography screening visits. For instance, a feasibility study of a lifestyle intervention within a breast cancer screening programme led to improvements in BMI, waist circumference and physical activity. The study also indicated that women were aware of the benefits of a healthy lifestyle, but were less aware of its role in reducing breast cancer risk. Marina Pollán of Spain emphasised the potential impact of rising obesity in Europe and worldwide: research indicates that obese women have a higher incidence of post-menopausal breast cancer, their tumours tend to be larger and more aggressive and can have a worse prognosis than in non-obese women. Susan Knox described the ED Breast Health Daycampaign, which aims to increase awareness of healthy lifestyle factors in decreasing risk of breast cancer later in life. She noted that healthy lifestyles also help in reducing risk of recurrence and in helping women adhere to their breast cancer treatments. In a subsequent session, exercise was noted to be an effective approach to reducing side effects of treatment and one that gives women more of a sense of control over the disease.

For more on Breast Health Day

European Code Against Cancer

As many more women are living with and beyond breast cancer, they may have psychosocial, financial, and treatment-related concerns and so on. ED Past President Elizabeth Bergsten-Nordström described the obstacles some women face in obtaining insurance, whether health, life or travel. She said that insurance company policies have not evolved in step with the progress made in breast cancer treatments and the price of insurance often exceeds the benefit. She added that specific grounds for anti-discrimination in the EU treaty do not include having a chronic disease and suggested that this is an area for advocacy. ED Vice President Evi Papadopoulos spoke about the perceptions and challenges of women living with metastatic breast cancer. Many women are expected to cope with anxiety, depression, losing control of their bodies, as part of the disease process. She said that women need encouragement, support and empowerment, help in dealing with side effects of treatment as well as with financial stress. Evi Papadopoulos was also a co-author of the late breaking abstract "Global Status of Advanced/Metastatic Breast Cancer (ABC/mBC): A Decade Report 2005-2015."

Read abstract 7LBA

In many countries, affordability of cancer care is an emotional issue rather than a practical one,David Taylor of the United Kingdom said in an opening presentation. For developed countries, cancer care is expensive but affordable. He added that the amount spent per person on cancer drugs is a fraction of that spent on alcohol, for instance. The ageing population rather than increasing health care costs, shifts them to a later date; the problem, he said, is that societies do not always make it easy for cancer survivors to work. In the ensuing panel discussion in which ED'sKaren Benn took part, the panel agreed that in developing countries or those with limited resources, access to treatment is often not the problem; it is access to infrastructure and adequately trained professionals. Creating a government body (or non-pharma) consortium responsible for research in Europe could foster studies and keep clinical trials in Europe. Fatima Cardoso, the EBCC10 Chair, pointed out that following the treatment guidelines should help to reduce unnecessary drug expenditures.

 

In a study based in Italy, 3,231 women with dense breasts and a negative mammography underwent tomosynthesis and ultrasound. The interim analysis showed that while ultrasound detected more additional breast cancers, tomosynthesis detected 50% of them and could be a potential primary screening method for women with dense breasts.

Read the article and editorial in the Journal of Clinical Oncology

In a subgroup of patients in the MINDACT trial with a low clinical risk based on the prognostic 70-gene signature, patients with multifocal disease were more likely to have a high genomic risk profile compared with those with unifocal disease, although the association was not as high as the researchers had expected. The effect of this association will be assessed in the future and could warrant multifocality being added to the decision-making process for adjuvant systemic therapy. EUROPA DONNA is a member of the MINDACT steering committee.

Read abstract 10

Radiotherapy to only the affected area of the breast after breast-conserving surgery has been associated with low rates of local recurrence at 5 years, similar to rates for radiotherapy to the whole breast. Women who had partial breast irradiation had greater satisfaction about breast appearance than those with radiotherapy to the whole breast. The UK researchers will follow the women for at least 10 years.

Read abstract 4LBA

A UK trial has found that neoadjuvant (presurgical) treatment of women with newly diagnosed, HER2-positive breast cancer with a combination of anti-HER2 therapy (trastuzumab + lapatinib) led to early reduction or absence of invasive disease in about one quarter of patients after only 11 days of therapy. This could help to identify women who could avoid chemotherapy. The researchers have emphasised that the findings are only for women with these disease characteristics and that the effect of this treatment on overall survival remains to be determined.

Read abstract 6LBA

At the conference closing, Roswitha Britz, commended the work of scientists and advocates and encouraged continued collaboration to reach the goals of high quality care for everyone with breast cancer. She emphasised the growth in patient advocacy since the first EBCC and the input of advocates in the current EBCC10 programme. The sessions "provided important information for advocates and have given us a better understanding about what actions we need to take as advocates when we get back to our countries."