UniSA research helping people avoid unnecessary breast cancer treatment

National Breast Cancer Awareness month

Dr Liz Buckley

Dr Liz Buckley, alumna and Research Fellow at UniSA’s Cancer Epidemiology & Population Health Research Group.

UniSA research is exploring ways for medical professionals to better predict which breast cancers will become life threatening compared with those that will not require invasive treatment.

Breast cancer is the most common cancer among Australian women, with one in eight being diagnosed with the disease by the time they turn eighty-five.

But thanks to advances in research, screening and treatment, more patients are likely to live longer and fewer women are dying from it than ever before.

In 2015, over 15,600 women and 145 men are expected to be diagnosed with breast cancer, affecting the quality of life of thousands of families across Australia.

And while mortality rates are declining, the number of women diagnosed continues to rise due to increased awareness of early detection and mammography screening.

Dr Liz Buckley, Research Fellow at UniSA’s Cancer Epidemiology & Population Health Research Group, completed her PhD at UniSA earlier this year.

Her thesis explored the prominent issue of over-diagnosis and over-treatment in women with cancers that may not have grown or become life-threatening if left undiscovered.

“There is a lot of uncertainty about whether certain high risk lesions, such as atypical hyperplasia and ductal carcinoma in-situ, increase the risk of breast cancer enough so as to warrant treatment,” says Liz, who focused her research on Australian women at high risk of developing breast cancer, such as women previously diagnosed with benign or non-cancerous breast diseases.

“There is some evidence that suggests some women will go on to develop invasive breast cancer, but this is not the case for all women.”

As a consequence of the high risk of cancer following breast disease, most women are treated as if they have early invasive breast cancer, “meaning that for any women who were unlikely to develop cancer, they are receiving treatment that they would not necessarily need.”

Before working within the Centre for Population Health Research, Liz conducted Health Technology Assessments for the Commonwealth Government, and assessed evidence relating to the safety, effectiveness and cost-effectiveness of digital mammography.

She learned a lot about the difficulties in introducing a screening program that provided clear benefits to women while minimising potential harms, and became aware of the concerns surrounding over-diagnosis of breast cancer.

“I’ve always believed in the underlying principle of screening, that is, improving outcomes by detecting and treating breast cancer early, but I realised that mammography isn’t necessarily a perfect screening test,” she says.

The national screening program for breast cancer, BreastScreen Australia, offers and recommends two-yearly screening mammograms for women aged between fifty and seventy-four.

BreastScreen Australia says mammography is the most effective screening test to detect breast cancer, with no other screening technology proven to reduce related deaths.

The program also says it is currently impossible to tell which breast cancers may become life-threatening and which may not; it was this gap in research that Liz decided to explore further through her PhD.

“If there was a way to identify which of those women would develop invasive breast cancer, then treatment could be provided to only those women, and any harm from over-treatment could be avoided,” she says.

While screening, along with the ageing population, has contributed to the increasing number of breast cancer cases diagnosed in Australia, Liz says mortality rates are declining, with survivorship becoming an increasingly important area of research.

As with all cancers, the spiritual wellbeing of breast cancer patients plays a major role in survivorship, with mental, social and emotional aspects of the disease as prominent and present as the physical.

Once cancer is discovered, whether by over-diagnosis or not, the wellbeing of the patient is of utmost importance, and researchers are working towards improving the quality of life for patients during treatment and in the years following.

“A patient’s physical wellbeing is inextricably linked to their emotional and spiritual wellbeing,” Liz says.

“Women with breast cancer are having better quality of life with the improvements that have been seen in treatments; this is particularly so with the increased use of breast conserving therapy instead of mastectomy for some women where, even though less breast tissue is removed, there is no difference in breast cancer survival.”

Despite advancements, there still remain extensive gaps in breast cancer research, so Liz is continuing her work by exploring the disease among South Australian Indigenous women.

“This is incredibly important given that Indigenous women are less likely to develop breast cancer in their lifetime, but if they do, they have poorer survival prospects. We need to understand not only breast cancer epidemiology in Indigenous women but also how the screening process works for this group of women.”

Liz was the recipient of the 2011 Bellberry Scholarship which allowed her to embark on her PhD journey and to contribute her research to the fight against cancer.

To support this research please visit: Support Cancer Research

By Anneliese Abela

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