World Oncology Forum 2015

Making the prevention of cancer a routine part of mainstream healthcare

Prof Jack Cuzick - Wolfson Institute of Prevention Medicine, London, United Kingdom

Just earlier this year we reported a median 16 year follow-up of data going right out to 20 years with the IBIS-I study of tamoxifen versus placebo in high risk women. We were very struck by the results that if you give tamoxifen for five years you get a continued benefit right out to 20 years of about a 30% reduction in breast cancer year on year. This could, of course, even continue beyond the 20 years so we’ll continue to follow up these women more.

Can you tell us about the IBIS-II trial?

IBIS-II was our second large prevention study, it focussed on the aromatase inhibitor anastrozole which was also published earlier this year. It looked at aromatase inhibitor anastrozole and we found a better effect with anastrozole than tamoxifen. It was not a direct comparison, it was anastrozole versus placebo but the benefits were in excess of 50% reduction in breast cancer and a 58% reduction in ER positive invasive breast cancer. So we think this is probably the treatment of choice for postmenopausal high risk women.

Is there a good uptake of women taking these drugs?

One of the great challenges, I think, now in cancer prevention or certainly preventive therapy, is that we do have to find ways to make these therapies more widely accepted. The cardiologists got around it by actually pointing out or creating high blood pressure and high cholesterol levels as a disease, not simply a risk factor, which could be treated and reimbursed. As a consequence there’s very good uptake of the statins and the drugs for lowering blood pressure and they’ve had a substantial impact. We need to find similar ways to actually make the prevention of breast cancer, for example, where we have good drugs, much more routine.

Do these drugs protect against osteoporosis?

One possibility is to emphasise the multiple preventative activities of some of the drugs. Many of the drugs, raloxifene, lasofoxifene and arzoxifene, were essentially developed as drugs to prevent fractures in women with osteoporosis. Of those, lasofoxifene looks the most interesting because it prevents fractures, breast cancer, strokes and heart attack. So there has only been one trial, it was a large trial of almost 9,000 women, but I think that’s a very attractive approach to have a preventative treatment which will prevent a range of major diseases.

Can you tell us about your work looking at the importance of exercise for breast cancer patients?

One of the, and possibly the most, interesting findings to come out of the IBIS-II studies is that it has long been accepted that the aromatase inhibitors lead to musculoskeletal aches and pains and arthralgia and, yes, there is a small increase. We had 64% of the women taking anastrozole reporting musculoskeletal aches and pains but in fact 58% of the placebo did. So much of this that’s being attributed to the drug is actually just time of life. If I had something I could blame my aches and pains on I certainly would. But it does call out for the fact that we do need to be aware of this as a real issue. Because these pains are linked to treatment it does lead to a lower compliance with treatment. I think we should begin to develop physical activity programmes as part of the treatment regimen for women with breast cancer. So when first diagnosed not only do they go along and get a blood sample and get all the tests but there should be an arrangement for them to begin to attend some sort of gym or something, or whatever they want to do, to talk to a trainer to try to get them more physically active. Because this is the only thing that’s really going to have an impact on aches and pains.

You’ve received an award from the American Cancer Society which is now acknowledging the importance of research on prevention – can you tell us more?

Yes, I was very honoured and really delighted to be given the Medal of Honour this year for clinical research by the American Cancer Society. I’m particularly delighted because I think this really highlights the fact that prevention is now becoming part of clinical research, it’s not a sideline. But to get the award in clinical research for cancer prevention really says this is now becoming more mainstream and recognised as being part of medicine and not simply a sideline. So that was delightful, that prevention actually was getting that little plug as well.