“Breast cancer remains a significant scientific, clinical and societal challenge,” write the authors of a large collaborative effort from over 30 UK institutions to analyse critical research gaps in preventing and treating breast cancer, as published in a recent Breast Cancer Research study.
This is an ambitious body of work that covers a vast, detailed analysis of the current state of affairs in breast cancer research, as well as the direction of future research. The authors, including Suzanne Eccles from the Institute of Cancer Research, UK and Alastair Thompson from the University of Dundee, UK, conclude that improved access to clinical tissue, new in vivo and in vitro models (including genetically engineered mouse models as well as patient derived xenograft models), new clinical trial methodologies, biomarker discovery and validation, and collaborations with physical scientists and engineers are all required to overcome some of the hurdles in breast cancer research. This well-written gap analysis identifies the following ten areas as significant research gaps:
1. Specific genetic and epigenetic changes during normal breast development and breast cancer
2. Identifying lifestyle changes
3. Screening approaches
4. Molecular pathology behind breast cancer subtypes, treatment resistance, and metastases
5. Tumour heterogeneity, dormancy, de novo and acquired resistance and how to target these processes
6. Markers for therapy resistance and sensitivity
7. Modern clinical trial development
8. Multimodality imaging
9. Survivorship issues
10. Clinically relevant and annotated tissue for translational research
This gap analysis is a brave attempt at identifying critical research questions that need to be answered in the short-term, foreseeable future. Contributed to by key opinion leaders in the UK, it succinctly summarizes the present and future of breast cancer research.
It remains to be seen if significant advances will be made in these areas, though greater awareness of survivorship issues and more collaboration, especially in areas of biobanking, ought to yield significant progress. Rethinking the design of clinical trials and screening approaches are tangible next steps. However, areas of more basic research, such as overcoming resistance, dormancy, epigenetic/genetic alterations, and markers of therapy resistance/sensitivity will remain challenging over the next decade.
It is important to note that the acquisition of clinically relevant, carefully annotated tissues requires collaborative teamwork and open dialogue between surgeons, pathologists, technicians, basic scientists, and medical oncologists. The resources needed to overcome some of these hurdles are indeed sobering and demand greater collaboration amongst different disciplines in order to attain these goals.