The impact of COVID-19 on breast cancer screening, treatment, research and meetings

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Published: 5 Oct 2020
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Prof David Cameron - Representative EBC Council

Prof David Cameron speaks to ecancer about the EBCC-12 virtual meeting.

Prof Cameron explains some of the challenges to screening, treating and researching breast cancer during the pandemic due to the strain on healthcare resources.

He talks about the importance of the conference at this time, stressing that while there are obvious disadvantages to not being able to meet in person this year there are also advantages to the virtual format. One of the advantages is being able to have a greater reach to low-middle income populations, as while the conference is run from Europe it welcome attendees from around the world.

Prof Cameron concludes by talking about his own sessions from the conference including a debate around breast cancer screening.

The European Breast Cancer Conference has run for many years. We meet every other year and we have met in various locations around Europe to try and facilitate access to the latest data on the management of breast cancer and have it put in context of what people do the following week when they go back to their own clinics. Obviously in the face of the tragic, catastrophic outbreak of COVID-19 in 2020 we had to suspend the original plan for the conference, which was to be in Barcelona in March of this year, but we decided fairly quickly that we didn’t want to just abandon the conference because we have understood from the many thousands of people who attend and access the information discussed that it seems to be for them an important conference to take back the new findings and new insights into their daily practice.

So earlier in the year we decided that we were going to go for a delayed conference and it became very clear that this was going to have to be a virtual conference which, of course, poses quite a lot of additional logistic challenges. Unfortunately, as everybody has discovered, you lose some of the benefits of a face to face meeting in that the conversations over coffee and around the conference discussing the latest data and potential new research questions just can’t happen in the way that it used to. Nevertheless, we felt it important to continue with the tradition and success of the European Breast Cancer Conferences and so we’ve had to go virtual. A lot of work has been done behind the scenes by the AV guys and girls and obviously the staff running the conference, as well as all the presenters who have had to prerecord most of the presentations that will be seen and heard at this meeting. And we hope that, in a way, by going virtual, given that nobody can travel, we may even be able to open the information at the conference to an even broader audience worldwide because we’ve always had people from across the world but it’s great to have even more opportunity for people across the whole world to share and learn at this year’s first ever virtual EBCC.

What are the challenges to screening, treatment and research during the pandemic?

COVID-19 has turned most of our healthcare services upside down and indeed for most of us it has turned upside down the way that we have had to live our daily lives. The initial wave, and the fear is that any second wave may do the same thing, swamped acute healthcare services, redirected efforts, energy and personnel away from slightly less urgent things than somebody falling into respiratory failure or some other COVID induced clinical crisis in front of you. Therefore cancer services across the board have been hit.

I, as a medical oncologist, have seen the biggest impact in that sense on the drug treatments we give and adaptations have had to be made to try and give equally effective treatment possibly in a way that is less risky to the patient, either in terms of the frequency of their attendance at hospital or the risks of becoming neutropenic and infected whilst on therapy. To be honest, though, I think the impact in other parts of cancer services has been even bigger. Most countries shut down their screening programmes and despite the various controversies I think most of us believe that screening for certain cancers clearly improves survival from those cancers. How suspension of screening and the gradual reopening will impact on that we have yet to see.

Diagnostics processes, many people get diagnosed with cancer through multiple routes into healthcare services. They don’t come to a cancer department usually, they come through other services. Many of their efforts were redirected to dealing with the many people acutely ill from COVID and actually access to diagnostics became more difficult. So we have evidence accruing that there have been some stage shifts with patients presenting increasingly with later stage cancers, possibly because of delayed access to diagnostics and in primary care. The primary care physicians are swamped, they’ve had to do more and more consultations remotely and many of us feel that there have been some delayed presentations as a consequence of that, without obviously blaming any particular part of the healthcare system for that result.

Everybody is trying to reopen services as best they can but if COVID becomes more prevalent again then there will be challenges in delivering the same level and speed of access to the entire cancer pathway that was normal a year ago. COVID has had a huge impact on people, on patients and on cancer patients in general and I applaud all those who have done their best to keep the services running as best as possible near normal.

Finally, research has been impacted on. Research is, I believe, core to and critical to cancer services but, again, if your hospital is struggling to deal with people who need ventilating then enrolling people into cancer trials will have to be a second priority to dealing with the acutely ill person in front of you. So many places had to reduce their research activity. They suspended recruitment to trials, adapted the way we ran trials to reduce the workload and patient visits, and I’m grateful for all parties involved in that from regulators, commercial trial sponsors, academic trial sponsors to adapt and to institutions to increasingly reopening their research portfolio.

Going forward, we don’t yet know the full impact of COVID on our cancer patients and our research and clinical activity but hopefully we can adapt even as COVID is becoming more prevalent again to try and maintain our services, including research and access to trials, as best we can.

What are some of the standout abstracts and themes from this meeting?

It’s hard to pull out individual abstracts. To me, the great strength of the European Breast Cancer Conference is that we don’t hone down on one particular area. We don’t just focus on drugs or radiotherapy or surgery or diagnostics; we’ve always tried to run a conference that brings all these components of cancer care. We have some data emerging from various studies such as MINDACT which have brought in newer molecular biology techniques to understanding which patients should and shouldn’t have treatment. We have some data on various new drugs, both preclinical in particular in the poster sessions, but also some of the clinical studies. We have debates touching on key topics and we will be discussing the impact of COVID.

I guess one of the really important questions in the drug adjuvant therapy of breast cancer are the apparently conflicting data from the two adjuvant studies with the two different CDK4/6 inhibitors, abemaciclib and palbociclib. We will be discussing and trying to understand these two apparently conflicting results.

But it’s hard, really, to pull out a single theme that I think is dominant, other than this being a multidisciplinary conference pulling together insights and new data from all the strands and components of breast cancer patients’ pathways.

What do attendees take away from EBCC? Why should they attend?

The best reason is because it’s an opportunity to hear new insights and new data. So not every abstract contains brand new unpublished or unpresented data; some of the abstracts undoubtedly contain data which is not so much new but pertinent. But it’s the opportunity to see it in the whole pathway of the breast cancer patient. We have a conference which is run between a collaborative breast cancer research group, the EORTC, EUSOMA, where there is a dominance, quite rightly, of the surgical part of the pathway, and a patient advocacy group.

The patients and their advocates are a core part of EBCC in a way that is unusual in the medical cancer conference world. Why do we do that?  Because ultimately people do breast cancer research, particularly clinical research, to improve outcomes for patients, so let’s bring them into the conference structure. I believe and sincerely hope that means that in some of the discussions and the data we see we get a truer reflection of the patient perspective of the data and how those data should be built into routine clinical care around the world.

So please come. I hope you’re there this year; I hope you come in future years because it is a truly multidisciplinary conference where the patients and their advocates are also partners along with diagnosticians, surgeons, drug therapists, palliative care physicians, nurses, radiotherapists, molecular biologists and preclinical researchers working together and sharing information together to improve the outcomes for breast cancer patients worldwide.

How does this translate to patient care?

The only thing I would add and, forgive me, I can’t even remember if we have one this conference, but many of our conferences we’ve had a session which is called something like ‘What should I do in clinic on Monday?’ So we’ve often had a summary session in the face to face conferences where we’ve asked someone to pull together their insights from the whole conference to say what do they want to take back to their clinic on Monday that they have learned here in the conference. That’s a theme, it is sometimes a specific session and I think it’s an important part of what the conference is about. It’s not just a dry abstract airing of data, it’s how does it impact on what you do back in the clinic.

Is there anything you would like to add regarding the meeting?

The final thing I would like to say is the conference is entitled the European Breast Cancer Conference, it is run by people based in Europe and the initial conferences were very much with a European theme. Geographically, until this year obviously, we have been physically holding the conference in a European venue. But I stress the fact that this is actually a worldwide conference. We have delegates from across the whole world: importantly, from North America, South America, Asia and the Far East. We have also deliberately targeted opportunities for younger researchers, both clinical and non-clinical, from the lower and middle income countries to try and bring their papers to the conference to genuinely reflect that breast cancer and fighting it is a worldwide task and insights from conferences should be applied, hopefully, worldwide. So whether you live and work in Europe or you don’t live and work in Europe you’re welcome to come to this and every future EBCC. Don’t be put off by the European name, it’s for everybody.

What sessions are you taking part in?

You’ve very kindly asked what am I doing myself in the conference, I’m talking part in a debate about the different ways we could do breast cancer screening. I think this is an important topic and I hope the debate, done in a typically British Oxford style where we use humour and the occasional dirty trick to illustrate the key themes so that people understand that we know there are controversies in breast cancer screening but each of us has our own view and I think that will become apparent.

I’m also doing a short session trying to give advice to those researchers who want to get their research idea funded, trying to help them look at their application from the perspective of the people who are making the decision. It’s very easy to believe that you’ve got the best trial idea since the last ten years but your job is to convince somebody else. So I’m doing a short session for people trying to get funding based on my own experience and my own failures as well as successes. I hope that sort of way of thinking will help people see that they need to translate their great idea into a language and a proposal that works for people who may know not so much about breast cancer but perhaps can approach their question with some rigorous methodological critique. Because we want the best studies funded to answer breast cancer questions.