Issue link: http://viewer.e-digitaleditions.com/i/85232
PI3-KINASE INHIBITORS Metastatic breast cancer remains an incurable illness despite a number of more effective treatments. New Zealand centres are participating in an international early phase clinical trial (called the "FERGI" trial) testing a new oral chemotherapy drug for postmenopausal women for a certain type of advanced or metastatic breast cancer. These drugs inhibit a protein called "P13-kinase" that may be involved in the growth and spread of some cancers. NEW RESEARCH FOR WOMEN DIAGNOSED IN PREGNANCY The incidence of breast cancer in pregnancy is estimated to be 1:3000 pregnancies. Breast cancer is the second most common cancer in pregnancy. Women are tending to delay childbearing until later in life so we are seeing more breast cancer related to pregnancy. It is difficult to differentiate cancer from physiological breast changes of pregnancy and during lactation – hence sometimes a delay in diagnosis. The Australasian Maternity Outcomes Surveillance System (AMOSS) is a national surveillance system in Australia and New Zealand. This was set up to look at rare and serious conditions in pregnancy and has recently had breast cancer in pregnancy included at the end of 2011. The aim of AMOSS is to set up safety and quality of maternity care in Australia and NEW ZEALAND. Findings from surveillance studies will be translated into reliable evidence based practice. See www.amoss.com.au Ethnic differences in outcomes for New Zealand women diagnosed with breast cancer Although our incidence of breast cancer is very similar to Australia, death rates from breast cancer are 20% higher in New Zealand. In New Zealand, Maori women fare even worse, with a higher risk of developing breast cancer and almost double the death rate compared with non-Maori. The inequalities in survival for Maori women have in part been attributed to the low up take of breast screening and later stage at /of? diagnosis. However, Maori women may have differences in other prognostic indicators such as more aggressive cancer biology. It is also possible that there are differences in the management of Maori compared with non Maori that may also influence survival. While New Zealand clinicians endeavour to offer similar treatment options regardless of race, there is some evidence that treatment options in Maori may at times be limited by other health conditions or by cultural considerations and aspects of care. Finding the reasons for worse outcomes in Maori (and also Pacific) women is a really important goal if appropriate interventions are to be put in place to rectify this. We need to identify areas where improvements can be made to reduce the inequalities in outcome for Maori, either through earlier diagnosis, improving access to breast screening and breast diagnostic facilities, and ensuring culturally appropriate and improved management and care of Maori women with breast cancer. It may be that breast cancers in Maori have some different biological characteristics e.g. more HER 2 positive cases, indicating we need to target these cancers with different treatments. Here in the Waikato we have embarked on a project to get all women with breast cancer diagnosed since 1991 onto our breast cancer register. We have a Commonwealth Scholar to undertake a PhD on this work. A complete and comprehensive dataset to analyse ethnic differences, such as this and those provided by the Auckland, Canterbury and Wellington Breast Cancer Registers is needed to do this type of work. Funding for these Registers is under threat, although the ethnic issues are just one vital question these datasets can potentially address. These registers have been generously funded by the New Zealand Breast Cancer Foundation and the Waikato Bay of Plenty Cancer Society (Waikato Register). The use of decision aids to assist patients with complex treatment decisions New Zealand centres have participated in Australian psychological research investigating the use of decision aid booklets to help women make decisions about such areas as; 1) what axillary surgery to undergo when diagnosed with breast cancer (e.g. sentinel node biopsy or axillary dissection) and; 2) for women at increased risk (e.g. due to family history) how to manage their breast cancer risk (e.g. whether to take the breast cancer medication called anastrozole to try and prevent breast cancer). Decision aid tools display and describe in different ways the risks and benefits of a particular intervention and look to be an important advance with regard to helping women understand complex issues. Australian researchers are also developing a web based decision aid for women deciding on prophylactic contralateral mastectomy (preventative surgery of the opposite breast). When diagnosed with one breast cancer, women often over estimate their risk of developing cancer in the opposite breast. This web based decision aid tool will be tested in an upcoming clinical trial. IN CONCLUSION These are just some of the clinical trials and research available in New Zealand. For women undergoing breast cancer treatment discussions, a cancer specialist may raise the option of a clinical trial. Alternatively, women can ask their surgeon or oncologist as to whether they know of any relevant trials available. A number of studies show that women participating in well conducted trials tend to have better outcomes even if they have received a standard treatment. This may be because most participants on a clinical trial receive carefully and often more rigorously monitored treatment and follow-up. It may also be because doctors involved in trials and research tend to be more up-to-date with the latest developments in breast cancer care and treatments. Ian Campbell is a Breast and General Surgeon and Jenni Scarlet is a Research Nurse based at Waikato Hospital. better outcomes even if they have received a standard treatment. A number of studies show that women participating in well conducted trials tend to have