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090: health&wellbeing Treatment Update Breast Cancer Research and WORDS BY: Ian Campbell and Jenni Scarlet More and more women than ever before are surviving a diagnosis of breast cancer thanks to early detection and more effective, safe and tailored treatments. It may surprise you to learn that breast cancer is not just one single disease. There are a number of sub types of breast cancer. Each woman who develops a cancer in her breast has a unique disease which can be identified by its cell make-up, its sensitivity to the female hormone oestrogen, and to the activity of certain genes within the tumour. Such individual characteristics create challenges for researchers in this field, to identify safe treatment that will give each woman the best chance of long-term survival and potentially cure. We need evidence based medicine and health care through clinical trials and research, so we can offer women as individuals the best treatment for their type of breast cancer. Clinical trials and research conducted today will lead to better outcomes for women of the future diagnosed with breast cancer. Research continues to answer questions about sentinel lymph node biopsy The status of the axillary or armpit lymph nodes remains the single most important indicator of outcome for women with breast cancer and may help predict the need for further treatment (e.g. chemo or radiotherapy). Traditionally, axillary node status has been determined by removal of most of the nodes (axillary clearance). This operation may lead to arm swelling (lymphoedema), pain, some abnormal skin sensation or shoulder stiffness. SENTINEL NODE BIOPSY VERSUS AXILLARY CLEARANCE (SNAC) 1 TRIAL This study has established that for women with small (< 3 cm) unifocal breast cancers, the surgical removal of the "sentinel" nodes (i.e. the first lymph node/s draining from the region of the breast cancer) provides accurate information as to whether axillary nodes are involved with cancer or not. Five year results were recently released and confirm the benefits of sentinel node biopsy with regard to less arm swelling, arm dysfunction (e.g. difficulties using the hand/ arm or raising the arm) and disability (e.g. difficulties doing hair, getting dressed, doing housework). The results showed that the difference in dysfunction and disability goes after the first 6-12 months. Arm swelling virtually all occurs within the first two years after surgery but then the arm measurements plateau. Factors that increased risk of arm swelling were infection and increasing BMI (weight). THE "SNAC 2" TRIAL. Following on from the initial SNAC 1 trial, surgeons in Australia and New Zealand are undertaking a second phase of this research which is investigating whether sentinel node based management is appropriate and preferable in women with larger or multi focal tumours and cancers of more aggressive biological type. This is a very important trial because very few women with larger tumours and none with multi focal tumours have been included in other randomised international trials of sentinel node based management. We know that with increasing tumour size there is an increased risk of cancer spread to the lymph node/s and we therefore need to very carefully evaluate the safe limits of this reduced surgery to the axilla. Waikato, Christchurch, Tauranga, North Shore, New Plymouth, and Taranaki Hospitals are centres for this research in New Zealand. Recurrence after mastectomy and survival for women with a newly diagnosed breast cancer In New Zealand, approximately half of women diagnosed with breast cancer are treated with mastectomy. Recently, there has been an international move towards much greater use of radiotherapy after mastectomy to treat breast cancer, driven by results from some treatment centres with high recurrence rates after surgery alone. For centres with lower recurrence rates, it is uncertain whether radiotherapy is needed. Radiotherapy treats breast cancer using high energy x-rays to destroy cancer cells. The aim of radiotherapy is to reduce the risk of the tumour coming back locally, and for a subset of these women to improve long term survival. Radiotherapy is routinely given to women when they are at "higher" risk of their breast cancer returning (e.g. when the tumour is large or when there are four or more lymph nodes involved with cancer). International controversy continues regarding which "intermediate" risk group of women require radiotherapy after mastectomy and an international clinical trial (called the SUPREMO trial) is underway to attempt to address this issue. The Waikato is the only New Zealand centre for this United Kingdom based trial.