Belfast Telegraph

Need for radical surgery could be thing of the past

By Stuart McIntosh

We know that women who carry a mutation in the BRCA1 gene (of whom there are several hundred in Northern Ireland) have a very high risk of developing breast and ovarian cancer in their lifetime – although, until now, the reason why women develop cancers in these particular tissues has not been clear.

This important laboratory study suggests that the female hormone oestrogen, and the chemicals resulting from the breakdown of oestrogen, may be responsible for the development of cancer in the breast in these women.

At present the only means we have to reduce the risk of developing breast cancer in these women is with surgery – to remove the breasts and/or the ovaries.

Such major, life-changing surgery is irreversible and has the potential for complications.

If we were to have a drug treatment (or a combination of drugs) that could be used to reduce the breast cancer risk in this situation then this would give us an alternative to surgery (or might allow us to at least delay surgery while still being able to reduce the cancer risk) in some women.

The results from Dr Savage's research suggest that by reducing oestrogen levels in the breast tissue it may be possible to reduce the risk of developing breast cancer.

There are already drugs available which may enable us to do this.

However, we don't yet know if the results from the laboratory will apply to real, living women who have this BRCA1 mutation.

That's why the next step in this research is a study to see if reducing oestrogen levels in women (rather than cells in the laboratory) will also reduce the risk of damage to DNA in their cells, and so possibly reduce the risk of breast cancer.

If this is really the case, then it might be possible to carry out a clinical trial in larger numbers of women to confirm that the drugs truly do reduce the risk of developing breast cancer in women who have a BRCA1 mutation – this would be a big step forward for this group of women, and could give us an effective alternative to surgery.

* Stuart McIntosh is a consultant breast surgeon at Belfast City Hospital, honorary senior lecturer at the Centre for Cancer Research and Cell Biology,Queen's University Belfast, and deputy clinical director of the Northern Ireland Cancer Trials Network.

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