CHALLENGES IN VERY EARLY BREAST CANCER WITH PROFESSOR BRUCE MANN

We spoke to Professor Bruce Mann about some of the key challenges in diagnosing very early breast cancer. Find out more in the article below.

Professor Bruce Mann is the Director of Research at Breast Cancer Trials, Professor of Surgery at the University of Melbourne and Director of the Breast Tumour Stream at the Victorian Comprehensive Cancer Centre.

His research interests focus on tailored screening and treatment for early breast cancer, and we spoke to him about some of the key challenges in diagnosing very early breast cancer.

“Very early breast cancer is interesting. What we know is that if breast cancer is diagnosed when it’s stage 1, so that’s when the cancer is less than 2cm in size and has not spread to the lymph nodes, the likelihood that that person will die from breast cancer is really small.”

“And the amount of treatment that’s needed is relatively small. This is an area that many people consider to be sorted because we have good treatments, and with existing treatments the results are extremely good. So, people would say, well, what’s the problem?”

“I see that it has become a challenge because why would you do research into an area that’s already sorted?”

“In addition, there’s quite a lot of controversy or there’s a lot of conversation around the issue of over diagnosis. The concept of over diagnosis, it is important, it is the diagnosis of a condition that, if undiagnosed, would never have become clinically significant in that person’s lifetime. And if you’ve got such a condition, then side effects of any treatment are actually a harm to the individual. That is they would be better off not diagnosed.”

“And so, some people suggest that we’ve got to that point with breast screening, that a lot of the things that are diagnosed should never have been diagnosed, and therefore there’s an ambivalence around screening, and the truth is there’s not that much research going into it.”

“My view and what I’ll be talking about in the conference is that this is an area where there is an enormous potential for us to improve breast cancer outcomes. And there’s two aspects to it. One that I won’t be talking about a lot on but is very much the focus of the session in the conference, is the possibility or the importance of moving away from current screening, which is all women 50 to 74 who are invited to have a standard mammogram every two years.”

“That’s what we’ve been doing since 1993. It’s what we’re still doing. There is, in my view, enormous potential to improve that by moving towards risk adjusted screening, which would mean that individuals would be assessed, and each woman’s individual risk would be determined.”

“And depending on the risk and on other things such as mammographic density, a more personalized screening program would be implemented. And we think that by doing that, we could have something that’s more effective.”

“So, we would find more cancers early, and it’s likely to be cost effective because by finding cancers earlier, treatment would not only be more effective but should be less expensive. So that’s one of the aspects that I would see as the challenges in very early breast cancer. It’s about finding more cancers and diagnosing more cancers at this very early stage.”

Listen to the Podcast

We spoke to Professor Bruce Mann about some of the key challenges in diagnosing very early breast cancer.

“The other aspect to it is the idea of optimizing treatment or de-intensifying treatment. The current treatments are very effective, but all treatments have side effects. Surgery has side effects, radiation has side effects, chemotherapy has side effects, and the hormonal therapies certainly have side effects.”

“Many women who have been diagnosed with breast cancer identify those side effects of treatments as quite severe and would like to be able to safely reduce them. Our current approach is that in my view we haven’t done enough research into that. And so, when we have a patient with one of these very early breast cancers, we say that here is the treatment we recommend and we recommend it not because we know that it’s needed, but we don’t know that it can be safely omitted.”

“And so most people would say, well, look, it’s important that the cancer doesn’t come back. So, if you don’t know that we can safely avoid that treatment, I will take it. And that is how things are. One of the things that we’ve done here is a number of trials in this area.”

“But one of the important ones is our PROSPECT trial, where we used MRI scans after diagnosis in someone with an apparently isolated low risk cancer, to look for other areas of cancer. And those women who had a clear MRI and had no additional cancers, and the cancer itself was low risk, were treated without radiation.”

“The results, we analyzed it a couple of years ago, and what we found is that in 440 women who had the MRI, we found additional areas of cancer in 11%. And they were all treated appropriately. In 201 women who met all the criteria, who were treated without radiation, there was only a single local recurrence at the five-year mark.”

“It was a 1% local recurrence rate, which is less than we hoped for, actually. We were surprised how good it was. But even more surprising, of all 440 women who had the MRI, we found those additional cancers and treated them. Not a single one of those patients has had the original cancer recur around the body.”

“There have been no distant recurrences. And that raises the possibility that perhaps this may be the way that we can find a group of women who could safely avoid, particularly the hormonal blocking tablets.”

“It’s still a hypothesis. We have a follow up study known as PROSPECTIVE, and part of the main aspect of PROSPECTIVE will be to confirm that we can safely omit radiation, but an additional arm will be to investigate whether we could safely reduce the amount of hormone blocking tablets, because if we could do that, it would truly be a big change in the way that breast cancer is considered.”

“It’s a number of years before we do it, but the PROSPECTIVE trial should open later this year and, that’s something that I’ll be talking about in my presentation at the conference on Thursday.”

How important is interdisciplinary collaboraton in treating patients with very early breast cancer?

“The interdisciplinary collaboration is absolutely critical. In PROSPECT, the key disciplines have been the radiologists who generally diagnose the cancers through screening and do the MRIs, the surgeons who do the surgery, the pathologists, and then the radiation oncologists, who assess the situation and confirm that this is a situation where omission of radiation is reasonable.”

“That will be really important going forward for our new study, particularly as radiation oncology has changed and we have new approaches using shorter treatment courses, so that will be important. Other groups who are important include the psychologists. One of the reasons for doing this is that we believe that there will be less psychological impact on patients who are assessed in this way and treated in this way.”

“We’ve been working with Associate Professor Lesley Stafford, who is a clinical psychologist, and her team to do work initially on PROSPECT, but certainly on PROSPECTIVE. And then when we move to the question of reducing the amount of endocrine therapy, the contribution of the medical oncologist will be critical as well.”

“I think the biggest barrier is that participation in breast screening is unfortunately too low. Numbers from BreastScreen Australia suggest that only about 52 or 53% of Australian women are having screening mammograms as suggested. The large majority of these very early cancers are diagnosed through screening.”

What are some of the barriers of challenges that exist in ensuring patients are receiving timely care for their breast cancer?

“So, if someone doesn’t have screening and she’s destined to develop a cancer, it is much more likely that her cancer will be more advanced. If someone has a higher stage of cancer, so a stage two or stage three cancer, the treatments are clearly essential to give her the best chance of survival.”

“My hope for the future of breast cancer care is that we get to a situation where the vast majority of patients who develop breast cancer are diagnosed at stage one or maybe stage two, really before the cancer has spread to the lymph nodes, so that we can use our effective treatments and fully expect that the cancer will not come back.”

“If we can do that, then there will always be a group who present at a later stage, and we will have the capacity and the resources to give those women the very best care that’s available.”

Support Us

Help us to change lives through breast cancer clinical trials research

Donate to Breast Cancer Research

Latest Articles

14/07/2025 – Breast Cancer General

PALB2 Gene

11/07/2025 – Clinical Trial Publications

Treatment Delays Progression of Aggressive Breast Cancer

A MEDICAL ONCOLOGIST AND RADIATION ONCOLOGIST DISCUSS OLIGOMETASTATIC BREAST CANCER

We spoke to Professor Prue Francis and Associate Professor Steven David about oligometastatic breast cancer, and the current standard treatment approaches for this disease.

Professor Prue Francis is the Clinical Head of Breast Medical Oncology at the Peter MacCallum Cancer Centre and a Consultant Medical Oncologist at St Vincent’s Hospital in Melbourne. She Chaired the International Steering Committee responsible for the SOFT and TEXT clinical trials, that have led to practice changes practice in the management of young women with hormone receptor positive early breast cancer.

Associate Professor Steven David is an experienced Radiation Oncologist at the Peter MacCallum Cancer Centre, bringing a strong interest in implementing cutting edge radiation technology to provide his patients with the highest level of care.

We spoke to Prue and Steven about oligometastatic breast cancer from the perspectives of a Medical Oncologist and a Radiation Oncologist, and the current standard treatment approaches for this disease.

Oligometastatic breast cancer is a term used to describe a specific situation in breast cancer. When breast cancer spreads beyond the original tumor, it’s called metastasis. Most metastatic breast cancer involves multiple spread-out tumors in various places.

However, in oligometastatic breast cancer, the cancer has spread but only to a limited number of places—typically, just a few distant spots like the bones, liver, or lungs. It’s different from more widespread metastasis because the cancer is not as scattered or extensive.

In simpler terms, if you think of metastatic breast cancer as a large network of many new tumor spots, oligometastatic breast cancer is like having just a few new spots. This smaller number of metastases can sometimes make it easier to treat and manage, often with a combination of local treatments (like surgery or radiation) and systemic treatments (like hormone therapy or chemotherapy).

The goal with oligometastatic breast cancer is often to control or reduce the spread and potentially extend the time before the cancer progresses further.

“So, traditionally we think of breast cancer as either being an early stage breast cancer, where the cancer is confined to the breast or the breast and the regional or the nearby lymph nodes, and then we talk about metastatic breast cancer where actually there is a spread of the breast cancer to a place that is distant from the breast and the nearby lymph nodes, for example the bone, the lung or the liver,” Prue said.

“Now, oligometastatic breast cancer has some similarities to metastatic breast cancer in that there are metastases that are distant from the breast and the nearby lymph nodes, but there is a limited number of metastases, so typically with oligometastatic breast cancer there’s a maximum of up to five metastases, so it’s a small number of metastases.”

What are some of the current standard treatment approaches for oligometastatic breast cancer?

“Well, typically, oligometastatic breast cancer would be treated more like metastatic breast cancer, and if there are a very limited number of distant metastases, for example, some patients might have only one distant metastasis, the question that arises is: could that patient actually be treated perhaps more like early breast cancer, but with some additional technique to try and eradicate that problem site, that single site of distant metastasis?”

“And so that’s why we try to think more carefully about this situation. We lack evidence for that sort of approach, but this is something that we think about, and we want to study,” she said.

Listen to the Podcast

What are some of the primary goals of radiation therapy when treating oligometastatic breast cancer?

“So, radiation therapy in the last 10 years has developed a new technique or a new modality of delivering radiation and it’s due to technology, and that technique or technology is called stereotactic radiation,” said Steven.

“It can be delivered to any part of the body and it’s different from any other type of radiation in that it can be delivered like a laser beam, very accurately, very quickly, and with almost none or very few side effects to anything around where you’re aiming it at.”

“And so immediately what people have thought about in oligometastatic breast cancer is why don’t we use that technique to eliminate the oligometastases or destroy them? We can do that very quickly in maybe 10 or 15 minutes with one or two treatments, with excellent long-term outcomes in terms of killing off the cancer in that spine,” he said.

“The question arises, is that a good idea? It’s certainly very attractive to patients, you know, if I’ve got a spot in the bone can you just get rid of it in 10 minutes? Well it sounds very attractive, but is it a good idea? And that’s where a lot of the research at the moment is centered around whether that is a good idea or not.”

How do you determine if a patient with breast cancer is suitable for radiation therapy?

“So, in the oligometastatic setting as technology has gotten better, we can distribute it more broadly, and in more situations. But there are some scenarios where you can’t do it. For example, if a metastasis is right near something that is very critical such as the spinal cord, it’s almost impossible to kill that deposit without also killing the spinal cord, and then it would be disastrous for a patient,” he said.

“So, location, number of metastases, size of metastases, and also if the patient’s had previous radiation, let’s say for a breast cancer, and then an oligometastases is nearby, it makes it very challenging because you’re overlapping with treatment you’ve given in the past. And so those are the sorts of factors we look at and think about.”

“When we decide if someone’s safe for oligometastatic treatment. One of the earlier studies that was done in oligometastatic breast cancer was looking at patients with a few different types of malignancies. There was lung cancer, there might have been prostate cancer, breast cancer, different types of malignancies, but all with a small number of metastatic sites.”

“And this trial was trying to look at if those patients had their disease otherwise controlled by a drug therapy that they’d started on, if they could try to deliver a dose of either radiation or perhaps surgery to a site, could you actually give them a better outcome by eradicating those local tumours, and just focusing on those distant metastases?”

“And that trial suggested that there was a survival advantage. It was not a very large trial, but it suggested that there was a survival advantage. But the number of breast cancer patients in the trial was relatively small. It wasn’t only a trial looking at breast cancer.”

“Then more recently, there’s been a trial that was trying to address this question again, but in a specific breast cancer population. And again, thinking about whether trying to eradicate those small number of sites of distant metastases could lead to a better outcome in terms of survival. And, in fact, that follow up trial actually did not show a benefit in overall survival.”

“So, I think we’re in a situation where we know we can deliver local radiation to these sites and potentially get some control of those sites, but whether that actually ultimately impacts the patient’s overall journey with metastatic breast cancer and their survival has not actually been clearly shown in breast cancer.”

“So, we really need more information to say that we should be doing this, really to routinely offer this. So, it remains really something that needs to be proven for breast cancer.”

In what ways does personalised medicine play a role in treating oligometastatic breast cancer?

“It’s a good question and I think I can answer it with starting with examples of two different sorts of patients. So, for example, there might be a patient who had breast cancer 15 years ago and had it treated successfully. And then 15 years later, they develop one bone metastasis. That patient has oligometastatic disease. A similar patient, in my case, has oligometastatic disease, and turns up with three bone metastases on the same day that they’re diagnosed with their primary, and that’s part one,” said Steven.

“And part two is, there are patients with different subtypes of breast cancer. We talked about HER2-positive, there’s triple negative, and there’s other types. So, these trials generally group all those patients together and call them all oligometastatic patients, and we now know that there’s different types of oligometastatic disease, and so I think whenever you start research you group everyone together and try and find a bit of an answer to a global question because it’s very hard to recruit very narrow groups of patients.”

“But I think where we’re heading now is really looking at subtype specific patients and researching them differently because we do believe that it’s possible there might be very different answers for those different patients. So that’s the subject of ongoing research and investigation,” he said.

“I guess there’s one type of patient group with very limited metastatic disease that probably people would agree requires a standard of care to try to eradicate that disease and that’s with a central nervous system metastasis (CNS), where it would be considered a standard of care to try to either surgically and or radiate that limited metastatic burden. That would be considered a standard of care.”

What are your hopes for the future?

“Well, in the oligometastatic setting the attractive thing is that it has never been thought that you could cure metastatic disease, and really that’s something across all of cancer. So, it’s a bit of a prior golden egg, a prize really, patients would love it and doctors obviously would love it if we could cure stage four disease,” said Steven.

“And I’ve seen Prue give a talk on that topic, on HER2-positive breast cancers, and she thinks they will be cured sometime soon. And perhaps radiation stereotactic to small deposits may be part of that story. And I think that would be a fantastic thing to talk about and to be able to say to patients, we’re going to cure you, even though it’s spread beyond the breast. And there’s every chance that’ll be in our lifetime, I think,” he said.

“I think in the area of oligometastatic disease, we have a few new tools in our kit bag from a drug therapy point of view that haven’t previously been tested formally in patients with oligometastatic disease. They’re things that we now would use in a higher risk, early-stage breast cancer patients,” said Prue.

“For example, a PARP inhibitor in a patient with a BRCA mutation or a CDK4/6 inhibitor in a patient with ER-positive HER2-negative high-risk disease, or perhaps immunotherapy in a high-risk triple negative breast cancer patient.”

“So, the question is, if we were to apply these types of therapies in the context of the overall treatment paradigm for a patient with an oligometastatic disease with those specific features, could that translate into any difference in a patient with a very limited number of metastases? Could that translate into any cures? Because at this stage we don’t have good information on how that would work with those newer therapies,” she said.

Our life-saving breast cancer research is only possible thanks to the continued generosity of our supporters. Please help continue this vital work by making a donation today.

Support Us

Help us to change lives through breast cancer clinical trials research

Donate to Breast Cancer Research

Latest Articles

14/07/2025 – Breast Cancer General

PALB2 Gene

11/07/2025 – Clinical Trial Publications

Treatment Delays Progression of Aggressive Breast Cancer

BREAST CANCER AND HEART DISEASE

Explore how breast cancer treatments can impact heart health, from chemotherapy risks to radiation effects. Learn vital heart care tips for survivors.

Breast Cancer and Heart Disease: Understanding the Link

Breast cancer treatment has dramatically improved outcomes for patients, yet it also poses significant long-term health considerations, particularly cardiovascular implications. Understanding the intricate relationship between breast cancer treatments and cardiovascular disease (CVD) is crucial for optimising patient care and survivorship.

Cardiovascular disease (CVD) encompasses a range of conditions affecting the heart and blood vessels. In Australia in 2022, an estimated 1.3 million Australians aged 18 and over (6.7% of the adult population) were living with one or more conditions related to heart, stroke and vascular disease, based on self-reported data from the Australian Bureau of Statistics (ABS) 2022 National Health Survey. This includes 600,000 adults (3.0%) who reported having coronary heart disease (including angina and heart attack).

Can Breast Cancer Affect Your Heart

Women diagnosed with breast cancer have a higher risk of developing cardiovascular complications, such as heart failure, heart attacks, and hypertension. There are several factors that contribute to this:

Treatment Effects: Some treatments for breast cancer, such as certain chemotherapy drugs and radiation therapy, can have adverse effects on the heart and blood vessels. This is known as cardiotoxicity – damage or dysfunction of the heart muscle caused by medications or treatments. Recognising the signs of cardiotoxicity is crucial for early intervention and management. Symptoms may include shortness of breath, chest pain or discomfort, fatigue, swelling and irregular heartbeat.
Shared Risk Factors: Breast cancer and cardiovascular disease share common risk factors, including obesity, smoking, physical inactivity and poor diet. Addressing these risk factors through lifestyle modifications can reduce the risk of both diseases.
Hormonal Factors: Estrogen, a hormone that plays a key role in breast cancer development, may also affect the cardiovascular system. Women who undergo hormonal therapy for breast cancer may experience changes in their cholesterol levels and blood pressure, which can contribute to cardiovascular complications.

Cardiotoxicity

Cardiotoxicity refers to cancer treatment-related damage to the heart muscle (which in some circumstances can be reversed). Cardiomyopathy is a broader term for disease of the heart muscle that can be caused by cardiotoxic treatments as well as other diseases (such as ischaemic heart disease).

In cardiomyopathy, there is a structural change to the heart muscle, which is usually permanent, that affects its ability to pump blood effectively. In severe cases cancer treatment can cause heart failure (a condition where the heart muscle is unable to pump blood efficiently enough to meet the body’s needs) or patient death.

There has been significant improvement in cancer patients’ outcomes over time. In Australia, there is currently a 70% chance of surviving at least 5 years after a cancer diagnosis. However, whilst living longer because of improved cancer care, cancer patients are increasingly developing CVD due to complications of their cancer treatments. Cancer survivors have up to an 8-fold increased risk of developing CVD, and up to 25% of cancer survivors die from CVD that develops within 7 years of their cancer diagnosis, making it the leading cause of death in cancer survivors.

Chemotherapy-Induced Cardiotoxicity

The two main classes of breast cancer treatments that cause cardiotoxicity are anthracycline chemotherapy and targeted therapies. Anthracyclines, such as doxorubicin and epirubicin, can cause dose-dependent damage to the heart muscle via the generation of free radicals and oxidative stress. Targeted therapies including HER2 inhibitors, such as trastuzumab, can also affect the heart by interfering with signalling pathways preventing the heart from functioning normally.

Patient and treatment factors can increase the risk of cardiotoxicity. Patient factors such as age, obesity, hypertension, diabetes and pre-existing CVD can increase a patient’s risk. Treatment factors include the cumulative dosage of certain drugs, and particular treatment combinations (whether this be the combination of specific drugs, or certain drugs in combination with other treatments such as radiotherapy).

Radiation-Induced Cardiotoxicity

Radiation can cause cardiotoxicity primarily due to its impact on the heart tissue and the blood vessels that supply it. This can include:

Direct Damage to Heart Tissue: High doses of radiation can damage the heart muscle directly. This damage can impair the heart’s ability to contract properly, leading to decreased cardiac function.
Inflammation: Radiation can trigger an inflammatory response in the heart. This inflammation can cause damage to the cardiac cells and tissues, potentially leading to fibrosis (scarring) and reduced heart function.
Vascular Damage: Radiation can cause fibrosis and damage to the coronary arteries and other blood vessels. This damage can lead to reduced blood flow to the heart muscle, increasing the risk of insufficient blood supply and heart attacks.
Altered Cardiac Function: Over time, the effects of radiation-induced damage can alter the normal function of the heart, leading to conditions such as heart failure, arrhythmias (irregular heartbeats), or other forms of cardiac dysfunction.

The overall effect of radiation damage to the heart and blood vessels can increase the risk of developing cardiovascular diseases later in life. This is particularly a concern for individuals who have received radiation therapy for cancer treatment.

These effects can vary depending on the dose of radiation, the duration of exposure, and the specific area of the body that was irradiated. The risk of cardiotoxicity is higher with higher doses of radiation and with treatments that involve radiation to the chest area

It is also important to note that the radiation doesn’t travel very far from the treatment area. So it is usually safe to be with other people. However, as a precaution you will need to avoid very close contact with children and pregnant women for some time. Your treatment team will give you specific advice about this. If you have any concerns about your personal medical treatment, we recommend discussing these with your treating team or GP.

Monitoring and Management

Cardiovascular complications can often display as fatigue, shortness of breath, decreased exercise tolerance, chest pain, palpitations, lightheadedness, headache, swelling or sudden weight gain.

Most side effects of cancer treatment show up in the first 12 months after treatment. Patients are encouraged to report any new or persistent symptoms to their healthcare team for comprehensive assessment and management.

Cardiovascular monitoring before, during and after breast cancer treatment can help detect cardiovascular complications early. This can include assessments of cardiac function through echocardiograms, and use of blood tests to identify early signs of cardiotoxicity. Treatment strategies may include drug adjustments, lifestyle modifications, and cardiac rehabilitation programs.

Unfortunately, despite identification and treatment, some cardiovascular complications of cancer treatment can be permanent, so ensuring patients are aware of potential cardiovascular complications of their cancer treatment allows them to be involved in their cardiovascular health monitoring and treatment.

Long-term survivorship care of breast cancer patients should include tailored strategies to reduce any cardiovascular risks. Lifestyle modifications, including smoking cessation, adoption of a heart-healthy diet, regular physical activity, and stress management play pivotal roles in promoting cardiovascular health post-treatment. Support groups and survivorship programs offer valuable resources and emotional support throughout the recovery journey.

Preventative Strategies

Unfortunately, there is no way to directly prevent cardiotoxicity, however there are steps you can take which may reduce your likelihood of cardiovascular risk, including:

Controlling blood pressure
Lowering cholesterol
Maintaining a healthy blood glucose level
Consuming a healthy diet
Not smoking
Engaging in moderate aerobic exercise

It’s important to discuss the potential health risks and benefits of treatments with your provider if you’ve been diagnosed with cancer. Undergoing frequent heart imaging throughout your cancer treatment may increase your chances of diagnosing cardiotoxicity in its early stages.

Learn More About Breast Cancer and Heart Disease in Our Online Q&A

In our recent Q&A event, moderated by Author and Journalist, Annabel Crabb, our panel of experts explored the topic of breast cancer and heart health; the nature, prevalence and management of cardiotoxicity and cardiovascular disease after breast cancer; strategies for prevention; a multidisciplinary team approach to risk management including the role of GP’s and cardiologists; and self-management strategies to reduce cardiovascular risk.

We also heard a patient’s perspective on the long-term impact that breast cancer treatment had on her heart.

Get Support

The relationship between breast cancer and heart health underscores the importance of comprehensive care for breast cancer patients. By better understanding this connection, health professionals and patients can take proactive steps to mitigate risk factors and monitor cardiac health, and individuals can optimize their long-term health outcomes and quality of life.

Supporting someone going through cardiotoxicity involves both practical and emotional support. Here are some ways to offer meaningful help:

Practical Support

Medical Appointments: Help them keep track of medical appointments and treatment schedules. Offer to accompany them to appointments if they’d like.
Medication Management: Assist with organising medications, keeping track of doses, and ensuring they take their medications as prescribed.
Monitoring Symptoms: Help them monitor and document symptoms such as shortness of breath, swelling, or fatigue. This can be useful for healthcare providers.
Diet and Lifestyle: Encourage and help them maintain a heart-healthy diet and lifestyle. This might include preparing nutritious meals or helping with exercise routines that are approved by their healthcare provider.
Emergency Preparedness: Ensure they have a plan for emergencies, including knowing when to seek immediate medical help if symptoms worsen.

Emotional Support

Listen and Validate: Be a compassionate listener. Acknowledge their feelings and concerns without judgment.
Encourage Open Communication: Support them in discussing their condition with their healthcare team and asking questions about their treatment and prognosis.
Provide Reassurance: Offer reassurance and encouragement. Remind them that their healthcare team is there to help and that treatment plans are designed to manage and mitigate risks.
Create a Supportive Environment: Help create a calm and supportive environment at home. This could involve managing stressors and providing a comforting presence.
Encourage Social Interaction: Encourage them to stay connected with friends and family, as social support can be very beneficial for mental and emotional well-being.
Educate Yourself: Learn about cardiotoxicity and its management so you can better understand what they are going through and how to offer relevant support.

Professional Support

Counseling and Therapy: Encourage them to seek counseling or therapy if they are struggling emotionally. Professional support can be crucial in managing the psychological impact of dealing with a chronic condition.
Support Groups: Help them find and connect with support groups for individuals dealing with cardiotoxicity or similar health issues. Sharing experiences with others who understand their situation can be very comforting.
Healthcare Coordination: Assist in coordinating care among their various healthcare providers to ensure they are receiving comprehensive and cohesive treatment.

FAQs

Can Breast Cancer Cause High Blood Pressure?

Breast cancer and high blood pressure (hypertension) are not directly related. However, several factors related to breast cancer and its treatment can contribute to elevated blood pressure:

Cancer Treatments: including chemotherapy, hormone therapy and targeted therapies.
Medication Side Effects: steroids used to manage side effects of cancer treatments or to treat inflammation can lead to higher blood pressure.
Stress and Anxiety: the stress and anxiety associated with a cancer diagnosis and treatment can contribute to elevated blood pressure. Chronic stress can impact cardiovascular health and increase hypertension risk.
Underlying Health Conditions: individuals with pre-existing conditions like pre-hypertension or heart disease may experience worsening of these conditions due to cancer treatments or stress.

Can Radiation for Breast Cancer Cause High Blood Pressure?

Radiation therapy for breast cancer is not commonly known to directly cause high blood pressure (hypertension). However, several indirect factors related to radiation therapy and its impact on the body can contribute to elevated blood pressure:

Impact on Heart: radiation to the chest area can cause damage to the heart and blood vessels. This damage can lead to increased risk of cardiovascular diseases, including hypertension.
Inflammation: radiation can induce an inflammatory response, which might affect the cardiovascular system and contribute to hypertension.
Secondary Effects: during and after treatment, patients might have changes in their lifestyle, such as reduced physical activity or dietary changes, which could affect blood pressure.
Medication Interactions: while radiation itself is less likely to cause high blood pressure directly, some medications used in combination with radiation therapy might influence blood pressure.

Can Breast Cancer Cause Heart Palpitations?

Anxiety, depression, sleep disturbance, fatigue, cognitive dysfunction, and pain are common symptoms reported by patients with breast cancer. Recent evidence published in the European Journal of Oncology Nursing, suggests that palpitations, a feeling of the heart racing or pounding, may be equally common for breast cancer patients.

If you have heart palpitations with severe shortness of breath, chest pain or fainting, seek emergency medical attention. If your palpitations are brief and there are no other concerning signs or symptoms, make an appointment to see your healthcare provider.

Can Breast Cancer Cause Chest Pain?

Secondary breast cancer means that a cancer that began in the breast has spread to another part of the body. It is also called advanced or metastatic breast cancer.

The symptoms you have depend on where the cancer has spread to. The symptoms listed here can also be caused by other medical conditions so might not be a sign that the cancer has spread, however, you may have any of these symptoms if your cancer has spread into the lungs:

a cough that doesn’t go away
shortness of breath
ongoing chest infections
chest pain
coughing up blood
a buildup of fluid between the chest wall and the lung

It is important that if you experience chest pain and breast cancer, or any of the above symptoms throughout your breast cancer treatment you discuss these with your treatment team.

Improving Cardiovascular Care

There are many ways to improve the cardiovascular care, and hence outcomes and quality of life of breast cancer patients. This includes:

Baseline cardiovascular assessments of cancer patients and consideration of this risk in cancer treatment recommendations
Proactive monitoring of cancer patients to detect cardiovascular complications of cancer treatments early
Multidisciplinary care between oncologists, cardiologists and general practitioners to manage cardiovascular risk and any established cardiovascular disease
Increased research into occurrence and treatment of cardiovascular complications of cancer treatments

Support Us

Help us to change lives through breast cancer clinical trials research

Donate to Breast Cancer Research

Latest Articles

14/07/2025 – Breast Cancer General

PALB2 Gene

11/07/2025 – Clinical Trial Publications

Treatment Delays Progression of Aggressive Breast Cancer

THE OLIO CLINICAL TRIAL WITH STUDY CHAIR DR STEPHEN LUEN

Dr Stephen Luen is the study chair of the OLIO clinical trial and we spoke to him about the aim of this research, how it might improve patient outcomes, and his hopes for the future of breast cancer research.

Breast Cancer Trials is dedicated to finding new and better treatments and prevention strategies for people affected by breast cancer. OLIO is an immunotherapy clinical trial which is examining whether the addition of a Olaparib to standard chemotherapy with or without durvalumab will improve outcomes for young premenopausal women with high-risk early breast cancer.

“So, recently we published some data looking at a very young women with hormone receptor positive breast cancer to try to understand what features in their breast cancers might give clues as to why their cancers may be more aggressive or have a higher chance of recurrence. And based on those findings, we’ve proceeded with a trial concept to try to add in targeted therapies for a subgroup of these tumors to improve their outcome.”

What is the aim of the OLIO clinical trial?

“So, we know that in hormone receptor positive breast cancer in young women, that they can have an elevated risk of recurrence, up to two to three times that of older patients. And the aim here is to target particular features of the tumor, and in this case, that’s called homologous recombination deficiency, with treatments that are dedicated to targeting those pathways to improve the chance that when we do an operation there is no tumor left over, but also to improve the outcomes in terms of the chance of cure to prevent recurrence.”

“So the aim of this trial is to develop the optimal treatment pathway for these patients to improve their chance of cure.”

Listen to the Podcast

How prevalent is HR-positive breast cancer?

“Yeah, that’s a good question. So, hormone receptor positive, HER2 negative breast cancer is the most common breast cancer subtype of all breast cancers that we diagnose. It makes up about 70 percent of cancers. However, the typical hormone receptor positive breast cancer is in post-menopausal women and older women. So, it is quite unusual for a young woman to develop breast cancers that are hormone receptor positive, HER2 negative.”

“And for this reason, we’ve investigated this more closely, and with the elevated risk we wanted to identify why these patients are getting cancer, but also how to best treat them.”

Why might young women with HR-positive breast cancer have higher rates of recurrence?

“So, it’s not totally clear why these tumors have a higher rate of recurrence. There are a couple of things that we do know. So, when we look under the microscope at features that show how aggressive the cancer is, in other words, how rapidly we think that cancer is growing, in young women we can see that they have much more aggressive cancers than their older counterparts.”

“There may be several reasons for that. We imagine that homologous recombination deficiency leads to a situation that is called genomic instability, where you accumulate more changes in the DNA of the tumor that can make the cancer more aggressive. There are also other features, so for example, young women may have higher levels of estrogen compared with postmenopausal women, and because these breast cancers are driven by hormones, it may be that in that situation they have more aggressive features.”

“In patients who have homologous recombination deficiency, there is some defect in the body’s ability to repair DNA changes. When we give a Olaparib, which is a class of drug called a PARP Inhibitor, it further decreases the ability to repair DNA. And when this occurs, you can get a massive accumulation of changes in the DNA of the cell, which causes that cell to die because it cannot cope with that level of DNA damage.”

“So, this is how the Olaparib drug works in this situation, and we think it probably works even better or synergizes with chemotherapy which causes cell death through its usual pathways.”

“I have a strong belief that we should be doing clinical trials directed to specific ‘at need’ populations, and one of those is young women with breast cancer. We know from literature that they have a high risk of recurrence, but they also have several other needs that are unique to young people, and it’s always been my dream to develop a clinical trial in this setting.”

What role does the immune system play in trying to make a treatment more effective?

“So my lab and other people around the world have spent a lot of time investigating the immune system and its interaction with cancers, particularly breast cancer. And our lab has done a lot of work at looking at quantity of immune cells within a tumor itself, which is kind of like a surrogate marker for that interaction between the patient and the tumor.”

“And we know that there are subtypes of breast cancer that are much more visible to the immune system. So, for example, triple negative breast cancer is known to be more visible to the immune system and, indeed, we’ve seen some positive results with adding immunotherapy in this subtype.”

“There seems to be less of a role in hormone receptor positive tumors, however, based on some of the research we’ve done, we believe there is a subset of these tumors that do have a stronger interaction with the immune system. And part of what we’d really like to do here is identify which of those tumors have that robust immune sort of interaction, and whether we can then target that group with drugs that allow the immune system to be fully unleashed.”

“So, the OLIO clinical trial is looking to recruit a total of 56 patients, and the patients that are eligible are patients who are young, so aged less than 45 years, and they have hormone receptor positive, HER2 negative breast cancer that is deemed to be high risk. And they are going to undergo treatment with chemotherapy in what we call the neoadjuvant setting, which is chemotherapy before surgery.”

“To be eligible for the trial, patients can be recruited for something we call a prescreening, which involves simply doing a genetic test on the tumor to see if this feature we call homologous recombination deficiency is present. And if it is present, they then may be eligible to proceed with the full trial with the intervention.”

“I believe with the advent of new therapeutics; we’re really looking at using targeted drugs to improve the outcomes in particular subsets of patients. So, I think for the future what I’d really like to see is to be able to understand which subgroups are going to respond to these treatments so that we can really optimize their outcomes at a personalized treatment kind of level.”

“I’m super excited to be able to be given the opportunity to run a clinical trial like OLIO. And clearly for me, I strongly feel that this would not have been possible without the support of Breast Cancer Trials and so I’d really encourage anyone who’s considering supporting Breast Cancer Trials at all to strongly consider it, because it really helps to support important clinical trials that are run within Australia and New Zealand for our own patients. And so, it’s an exciting time to be involved in that sort of research.”

What are your hopes for the future?

“So, I think my hopes for this clinical trial, obviously, are that we see some positive results. If this is positive, I feel strongly that we should look to do a larger, what we call a registrational study, and that will enable this treatment to be fully accessible and available to the general public so that we can identify these high-risk individuals, particularly young patients, and we can treat them with the best possible treatment.”

Our life-saving breast cancer research is only possible thanks to the continued generosity of our supporters. Please help continue this vital work by making a donation today.

Support Us

Help us to change lives through breast cancer clinical trials research

Donate to Breast Cancer Research

Latest Articles

14/07/2025 – Breast Cancer General

PALB2 Gene

11/07/2025 – Clinical Trial Publications

Treatment Delays Progression of Aggressive Breast Cancer

OMITTING RADIOTHERAPY MAY IMPROVE QUALITY OF LIFE FOR BREAST CANCER PATIENTS

Treatment options and patient outcomes for those with early breast cancer have come a long way: patients diagnosed today have a better outlook compared to 25 years ago.

Despite better treatments, many side effects are still tough. The physical, mental and social impacts can linger long after the cancer is gone, leaving patients grappling with significant changes to their overall wellbeing.

As part of a Clinical Fellowship project with Breast Cancer Trials, psychologist and psycho-oncology researcher Michelle Sinclair studied how different breast cancer treatments impact a patient’s overall health-related quality of life.

Her work follows findings from the PROSPECT study, which aimed to identify settings where radiation therapy can be safely omitted for some patients with early breast cancer. Patients had an MRI before surgery and those with a single cancer with lower-risk pathology were treated without radiotherapy after breast conserving surgery. This study was led by Professor Bruce Mann and Dr Allison Rose at The Royal Melbourne Hospital, with the study sponsored by Breast Cancer Trials.

Physically treating cancer is one consideration – but what about the longer-term impacts of omitting radiotherapy for a patient’s physical, mental and social wellbeing?

New research led by Ms Sinclair and Associate Professor Lesley Stafford compared 400 women from three groups: women from the PROSPECT trial who omitted radiotherapy; those who received radiotherapy; and, women who were not part of the trial who received standard care (including radiotherapy without a pre-treatment MRI).

Participants completed questionnaires and semi-structured interviews to measure their concerns about recurrence, how they felt about their cancer treatment decisions, and their physical outcomes.

The research found that women who omitted radiotherapy had less fear of cancer recurrence and experienced fewer side effects compared to the other groups. They also had fewer differences between their treated and untreated breasts.

Ms Sinclair says that fewer side effects likely meant that “patients didn’t have as many triggers to remind them about cancer. We found that many women who didn’t have radiotherapy reported that their breast cancer treatment had a minimal impact on their lives.”

The findings show the importance of considering how different treatment options affect a patient’s psychological and social wellbeing, as well as physical outcomes. It’s also important for clinicians to build trust with patients through clear communication and personalised care.

“Patients were provided reassurance from the MRI and their treating clinician that their cancer was low-risk, and believed that their care was being personally tailored to them,” Ms Sinclair says.

“A lot of women who omitted radiotherapy said, ‘I don’t really think about [cancer] at all now’, which is a fantastic outcome.”

An international follow-up study to confirm PROSPECT’s results is underway, which will include a comprehensive assessment of the mental health and quality-of-life implications of omitting radiotherapy in low-risk breast cancer settings.

Publication:
Stafford L, Sinclair M, Butow P, Hughes J, Park A, Gilham L, Rose A, Mann GB. Quality of Life Outcomes Associated With Optimization of Treatment by Omitting Radiotherapy in Early Breast Cancer. Clinical Breast Cancer. 2024. In Press. Online 06 March 2024. https://doi.org/10.1016/j.clbc.2024.03.002

Support Us

Help us to change lives through breast cancer clinical trials research

Donate to Breast Cancer Research

Latest Articles

14/07/2025 – Breast Cancer General

PALB2 Gene

11/07/2025 – Clinical Trial Publications

Treatment Delays Progression of Aggressive Breast Cancer

UNDERSTANDING HOW BMI COULD IMPROVE BREAST CANCER TREATMENT: PALLAS FOLLOW-UP

Understanding the impact of medication on different body types could help clinicians deliver the best outcomes for breast cancer patients.

New analysis of data from the PALLAS trial (PALbociclib collaborative Adjuvant Study) has shown the need for further research to ensure that patients in specific Body Mass Index categories receive effective doses.

The PALLAS trial, from 2015–18, recruited nearly 5800 participants worldwide to explore whether palbociclib – a cell-cycle inhibitor effective in treating metastatic disease – improved outcomes when added to standard hormone treatment for early-stage HR-positive, HER2 negative breast cancer.

Although PALLAS didn’t produce the patient benefit researchers hoped for, Australian trial chair Dr Nick Zdenkowski says its results will drive investigation for a decade to come.

This follow-up study re-examined PALLAS data to understand the impact of patient BMI, which affects breast cancer risk and prognosis, on trial results.

While 42% of recipients of the study drug stopped taking it before the end of the two-year trial due to side effects like neutropenia (low white blood cell count) and fatigue, overweight and obese patients experienced fewer side effects, suggesting that they were exposed to a lower concentration of the drug.

“Overweight or obese women have a higher risk of developing breast cancer and worse outcomes after diagnosis,” says Dr Zdenkowski. “The cancer is more likely to return if they’ve been treated with curative intent, or they’re likely to have worse outcomes if their disease is advanced.”

“The researchers were concerned that overweight and obese participants might not have been getting enough of the PALLAS study drug and that there might not have been enough of it in their systems to affect the cancer cells.”

The new study found that wasn’t the case and that palbociclib provided no benefit across BMI categories, although Dr Zdenkowski says it wasn’t designed to answer that specific question.

It did, however, highlight the need to consider BMI in treatment planning.

“Given that many overweight and obese people around the world will still receive [palbociclib] in a metastatic setting, are we potentially doing them a disservice by putting them on the standard dose?” asks Dr Zdenkowski.

The new study also confirms PALLAS’s findings that palbociclib provided no benefit for patients with early stage cancer. While disappointing, Dr Zdenkowski says it’s reassurance that the trial was sound.

“We wanted to know if there was truly a lack of benefit, or whether a different study design might have shown a benefit. But that wasn’t the case.”

Publication:
Impact of BMI in Patients With Early Hormone Receptor-Positive Breast Cancer Receiving Endocrine Therapy With or Without Palbociclib in the PALLAS Trial. J Clin Oncol. 2023 Nov 20;41(33):5118-5130. doi: 10.1200/JCO.23.00126. Epub 2023 Aug 9. PMID: 37556775.

Pfeiler G, Hlauschek D, Mayer EL, Deutschmann C, Kacerovsky-Strobl S, Martin M, Meisel JL, Zdenkowski N, Loibl S, Balic M, Park H, Prat A, Isaacs C, Bajetta E, Balko JM, Bellet-Ezquerra M, Bliss J, Burstein H, Cardoso F, Fohler H, Foukakis T, Gelmon KA, Goetz M, Haddad TC, Iwata H, Jassem J, Lee SC, Linderholm B, Los M, Mamounas EP, Miller KD, Morris PG, Munzone E, Gal-Yam EN, Ring A, Shepherd L, Singer C, Thomssen C, Tseng LM, Valagussa P, Winer EP, Wolff AC, Zoppoli G, Machacek-Link J, Schurmans C, Huang X, Gauthier E, Fesl C, Dueck AC, DeMichele A, Gnant M; PALLAS Groups and Investigators.

Support Us

Help us to change lives through breast cancer clinical trials research

Donate to Breast Cancer Research

Latest Articles

14/07/2025 – Breast Cancer General

PALB2 Gene

11/07/2025 – Clinical Trial Publications

Treatment Delays Progression of Aggressive Breast Cancer

UNLOCKING PERSONALISED PREVENTION: HOW HORMONE LEVELS GUIDE CANCER PREVENTION IN POSTMENOPAUSAL WOMEN

There is a groundbreaking approach to breast-cancer prevention in postmenopausal women – blood tests. Measuring hormone levels can identify women who would most benefit from anastrozole, a drug aimed at preventing breast cancer.

The IBIS-II clinical trial results were published in Lancet Oncology in December 2023 and shared at the San Antonio Breast Cancer Symposium.

The research delves into whether oestrogen levels in blood can pinpoint postmenopausal women at an elevated risk of developing breast cancer who would benefit from anastrozole’s preventive properties. The international randomised controlled IBIS-II prevention trial included nearly 4000 women globally, with 818 participants from Australia and New Zealand, and was spearheaded by Breast Cancer Trials in Australia and Cancer Research UK internationally.

Anastrozole belongs to a class of drugs known as aromatase inhibitors, recommended by the National Institute of Clinical Care and Excellence (NICE) for preventive therapy in high-risk postmenopausal women. These drugs halt oestrogen production, thereby reducing it in the body and they are the most potent preventive agents for oestrogen-receptor positive breast cancer. However, pinpointing those who would benefit most from these drugs would make them even more useful.

A nuanced analysis involved a case-control study of 212 women (72 cases, 140 controls), and revealed a marked trend: increased breast cancer risk correlated with rising hormone levels in the placebo group, a trend absent in the anastrozole-treated group. Notably, threequarters of women treated with anastrozole had a 55% reduction in cancer risk, with a diminished reduction noted among those with the lowest estradiol/sex hormone-binding globulin ratios.

“This data suggests that inexpensive blood tests to measure the ratio of these hormones, could be used to identify women who will benefit most from preventive therapy with an aromatase inhibitor,” said Dr. Nicholas Zdenkowski, the BCT Study Chair for the IBIS-II clinical trial. “This personalisation would allow for women to receive the medication that would offer them the best balance of managing cancer risk and side effects.”

Publication:
Cuzick, J., Chu, K., Keevil, B., Brentnall, A. R., Howell, A., Zdenkowski, N., Bonanni, B., Loibl, S., Holli, K., Evans, D. G., Cummings, S., Dowsett, M. (2023). Effect of baseline oestradiol serum concentration on the efficacy of anastrozole for preventing breast cancer in postmenopausal women at high risk: a case-control study of the IBIS-II prevention trial. Lancet Oncology. Published Online December 6, 2023. https://doi.org/10.1016/S1470-2045(23)00578-8

Support Us

Help us to change lives through breast cancer clinical trials research

Donate to Breast Cancer Research

Latest Articles

14/07/2025 – Breast Cancer General

PALB2 Gene

11/07/2025 – Clinical Trial Publications

Treatment Delays Progression of Aggressive Breast Cancer

THE BENEFITS OF DIFFERENCE: HOW TARGETING SUBTYPES OF A DEADLY CANCER COULD IMPROVE PATIENT OUTCOMES

Triple negative breast cancer (TNBC) represents about 15% of early stage diagnoses and has the worst prognosis of any type of breast cancer.

Recent developments in treatment strategies have improved outcomes, but it remains an aggressive disease. Patients with early stage TNBC are more likely to experience recurrence and die of their cancer, and those with metastatic disease to have a shorter survival.

Researchers have reviewed the results of a phase III clinical trial, conducted between 2000 and 2012, to explore the potential for lowdose chemotherapy to benefit patients with particular subtypes of TNBC in its early stage.

The IBCSG 22-00 trial examined the effects of continuous low-dose chemotherapy, using cyclophosphamide and methotrexate, for about 1000 patients with ER-negative cancer. Unfortunately, its findings showed no significant benefits in the disease-free survival rates of trial participants.

Dr Nick Zdenkowski, chair of the Scientific Advisory Committee for Breast Cancer Trials, says that while there is more understanding of the disease and new approaches to trial design since IBCSG 22-00 was completed, its rich data and tissue samples have enduring value.

Researchers have re-examined IBCSG 22-00, applying an updated perspective and revealing new information about how subtypes of the disease responded to the treatment.

TNBC is defined by what it lacks: estrogen, progesterone and HER2 markers. But as Dr Zdenkowski explains, this type of cancer isn’t homogenous. This new study focuses on the impact of low-dose chemotherapy on three specific subtypes.

“Researchers found that two of the three subtypes were more immune activated,” says Dr Zdenkowski. “There was a statistically significant benefit in those subgroups from this chemotherapy regimen.”

The new study has reinforced the need to further explore heterogeneity of TNBC and establish subtypes’ responses to both existing therapies and emerging strategies like immunotherapy.

“If we can find subtypes of triple-negative breast cancer that respond well to cyclophosphamide and methotrexate and then potentially add in some immunotherapy, that could be a very effective,” he says.

While not yet able to influence changes in patient care, the new data will benefit planning of next-generation trials and the development of new therapies.

“Having tissue specimens from trials [like IBCSG] in biobanks is hugely valuable,” says Dr Zdenkowski. “We can analyse specimens from patients who have volunteered their time and their bodies, and they are valuable for years and potentially decades to come. If the biobank is used wisely, then we can design our current trials based on that information.”

Publication:
Differential Benefit of Metronomic Chemotherapy Among Triple-Negative Breast Cancer Subtypes Treated in the IBCSG Trial 22-00. Clin Cancer Res. 2023 Dec 1;29(23):4908-4919. doi: 10.1158/1078-0432.CCR-23-1267. PMID: 37733800. Joaquin Garcia A, Rediti M, Venet D, Majjaj S, Kammler R, Munzone E, Gianni L, Thürlimann B, Laáng I, Colleoni M, Loi S, Viale G, Regan MM, Buisseret L, Rothé F, Sotiriou C.

Support Us

Help us to change lives through breast cancer clinical trials research

Donate to Breast Cancer Research

Latest Articles

14/07/2025 – Breast Cancer General

PALB2 Gene

11/07/2025 – Clinical Trial Publications

Treatment Delays Progression of Aggressive Breast Cancer

RETHINKING RADIATION IN EARLY BREAST CANCER: PROSPECT TRIAL HIGHLIGHTS

For those with early stage breast cancer, pre-surgery breast magnetic resonance imaging (MRI) could enhance patient wellbeing, improve treatment plans – and reduce the cost of treatment.

The primary results of the PROSPECT clinical trial, spotlighted in The Lancet (January 2024), was conducted by Breast Cancer Trials in Australia and led by Professor Bruce Mann.

Typically, radiation therapy following lumpectomy, or breast-saving surgery, is the norm to minimise the risk of cancer recurrence. However, the PROSPECT trial has challenged this standard by using MRI to identify low-risk early cancer patients, who might forego radiation. This innovative approach could revolutionise treatment approaches and yield considerable healthcare savings, estimated at $2,900 per patient.

The study involved 443 participants from 2011 to 2019 and used MRI to uncover additional cancerous areas in 11% of cases. With a median follow-up period of five years, only 1% of the 201 patients who skipped radiotherapy experienced a return of their cancer to the original site. In addition, only a small percentage of the entire trial cohort experienced local cancer recurrence – suggesting that detecting and treating the additional cancer areas was key for recurrence prevention.

The psychological benefits of the trial were also notable. Research presented at the 2023 San Antonio Breast Cancer Conference, found that patients bypassing radiotherapy reported less anxiety about their cancer returning and improved quality of life compared to those who underwent radiation.

“We are hopeful that this will pave the way for many of those diagnosed with early low-risk breast cancer to safely receive less intense treatment, with less physical and psychological impacts, while maintaining a very low risk of cancer recurrence,” said Prof Mann. He also underscored the need for a follow-up trial to confirm and expand on these encouraging findings.

Publication:

Mann, G. B., Skandarajah, A. R., Zdenkowski, N., Hughes, J., Park, A., Petrie, D., Saxby, K., Grimmond, S. M., Murugasu, A., Spillane, A. J., Chua, B. H., Badger, H., Braggett, H., Gebski, V., Mou, A., Collins, J. P., Rose, A. K. (2024). Postoperative radiotherapy omission in selected patients with early breast cancer following preoperative breast MRI (PROSPECT): primary results of a prospective two-arm study. The Lancet, 403(10423), P261-270. https://doi.org/10.1016/S0140-6736(23)02476-5

Support Us

Help us to change lives through breast cancer clinical trials research

Donate to Breast Cancer Research

Latest Articles

14/07/2025 – Breast Cancer General

PALB2 Gene

11/07/2025 – Clinical Trial Publications

Treatment Delays Progression of Aggressive Breast Cancer

BECOME A PINK CHAMPION FOR BREAST CANCER TRIALS LIKE FUGEN CONSTRUCTIONS

Here is a recap on the 2024 Cole Classic with race director, John Thompson, and the team at Fugen Constructions. By becoming a Pink Champion and entering a sporting event, your workplace can raise vital funds for breast cancer research.

Become a Pink Champion

For more than four decades, the Cole Classic has been a cornerstone event at the iconic Manly beach and is one of Australia’s most celebrated ocean swims and peer-to-peer events.

The Cole Classic hosts a one kilometer, two kilometer or five kilometer swim option, and encourages participants to fundraise for various charities.

“My name is John Thompson. I’m the Race Director of the Cole Classic. This is the fifth year that Manly Lifesaving Club has owned the Cole Classic, and it’s just getting bigger and better every year.

breast cancer trials john thomson jow 240124 1103 | 1

Pictured: John Thompson, Race Director of the Cole Classic.

“In 1983, a gentleman named Graham Cole started the Cole Classic. And he did his bronze medallion at Manly when he was a younger person.”

“And then he went over to Hawaii and swam the Waikiki Rough Water Challenge, and then he came back to Bondi, where he was living at the time, and decided he wanted to start a people’s ocean swim. An ocean swim that wasn’t exclusive to Surf Life Saving members.”

“Members of the public would come in and swim, and the Surf Life Saving Club would provide water safety. So, in 2005 the Cold Classic made its way to Manly. And that’s where it’s stayed ever since.”

“Last year we had 4,600, which was a record. This year we’re going to cap it at 5,100, a little bit over 10 percent increase, just to make sure that we can grow the event comfortably and still run a fun and safe event.”

“In terms of the teams, there’s lots of teams that have entered, a little bit over a hundred at the moment, but that could be anywhere from a two person, through to a hundred plus person team. I think we have two teams now that have over a hundred swimmers in each team and there’s some really awesome camaraderie that goes on there.”

Listen to the Podcast

In this episode, you’ll hear a recap on the 2024 Cole Classic with race director, John Thompson, and the team at Fugen Constructions. By becoming a Pink Champion and entering a sporting event, your workplace can raise vital funds for breast cancer research.

Mr Stephen Flannery, Managing Director of Fugen Constructions, describes what to expect, and the importance of supporting Breast Cancer Trials research through the Cole Classic.

“So, the name of the team, ‘The Rack Pack’ came up through Rachel and we decided to do a breast cancer aligned charity again this year, after 2010, we had the ‘Builders Love Boobs’ event.”

“So, it’s been 10 years since my wife passed away. So, the family decided we’d just do another swim for Breast Cancer Trials. So, we have this band of team members on this email list from people who have swam since day dot.”

“And we just send an email out in December some time saying that this is the charity that we’ve picked, and we set up the websites, and Nicole, my PA, runs most of that.”

“And after talking to some of the ladies in the office, because I thought I’d put it out to them, because that’s who are primarily affected, they said, everyone talks about post-treatment but what about actually trying to prevent it?”

“So, I thought, fantastic, and that’s when I got onto Professor Fran Boyle, and the Breast Cancer Trials organisation came up. So, the focus for me is why not try to stop it before you have to look after it? And we just thought, why not have a crack this year, and see how much we raise?”

breast cancer trials stephen flannery jow 240124 0716 | 2

Pictured: Stephen Flannery with Staff at Fugen Constructions.

“We’re currently at $36,000 hopefully we make $50,000, so for the whole swim team for over the 15 or 16 years that we’ve participated, it’ll be roughly $500,000 that we have raise for the various 16 or 17 odd charities that we’ve done. It doesn’t matter how much you raise or what you do, you just make a difference.”

“I was lucky that when I started, I had a really good passion for it, and it was an emotional thing for me. And every year has been a bit different for different people, but once you build the momentum, and everyone knows that in the first week in February, the Fugen team is going to be doing something, people get excited.”

“So, it just seems to be that people have just got this connection with really charitable people, and they’ve got really good sponsors. So, you know, they say Fugen raised all this money, but it’s 60 individuals that have raised a minimum of $200 each. So, they’ve got their parents, their best friends, there’s been 12-year-olds participating who have raised $200, and those girls now are now 24 and still raising money from their friends.”

“I’m lucky I’ve got a big support group of friends and people that we work with in the industry who are good suppliers, subcontractors, friends, and clients that are strong supporters. So, everyone wants to be involved. It’s good.”

Mr Reece Moffat, Construction Manager at Fugen Constructions, discusses the importance of supporting Breast Cancer Trials research.

“My name is Reece Moffat. I work at Fugen Constructions as a Construction Manager. I think most people are affected by breast cancer in some shape or form. I’ve got a lot of loved ones that have been directly affected by breast cancer, so it means a lot to raise money for Breast Cancer Trials this year.”

breast cancer trials cole classic team jow 240118 8032 | 3

Pictured: Reece with his Wife and their Baby.

“So, it’s a really rewarding time raising money, no matter what the fundraiser is, but especially for Breast Cancer Trials. Knowing that we’ve raised such a significant amount and how far that money will go really does give you a sense of achievement and knowing so many people affected by breast cancer directly or indirectly, it really does make you feel good about yourself to be a part of this.”

“This year will be my 11th consecutive year swimming in the Cole Classic and being part of Fugen Swim Team. Fugen Constructions build a swimming team every year. It begins within the company, so we’ll have the young cadets, all the way through to the senior project managers and site managers.”

“Everyone is welcome to compete, and then it’s spread out to their partners, their friends, and their family as well. So, my partner has been doing it for six years and she loves it. It’s a day in our calendar every year that we don’t miss.”

“Training is up to the individual. So, some people train when they get there on the day. Other people swim all year round, most of them start concentrating in January, but the admin of it starts probably in December. We start ordering shirts, sending emails out, and then Nicole registers the team in the Cole Classic and sets up the charity page as well,” said Stephen.

“And then the emails just start going out. I start my fundraising usually about the first or second week in January when everyone starts coming back. And then the team just grows from that with the weekly or fortnightly emails. And then the week leading up to the Cole Classic is probably the more intense part about organising, including the barbecues, tents, and food.”

“We feed probably between 100 and 120 people. By the time you have 50 or 60 in your swim team, then you’ve got people that don’t want to swim but want to support us. We’ve got parents there watching their kids, so it just varies about how many we have.”

“So, in the past three months I’ve ramped up the training for the Cole Classic. We are part of the back of the pack in the event. So, the less serious side of things, but we still like to stretch our arms and kick our legs before the event to get into the swing of things and not go in too cold”, said Reece.

“So, there’s a team of 60 odd this year. Some train, some don’t, and obviously we all try to get the best out of ourselves, while raising money for a good cause.”

We spoke with Race Director, John Thompson, about what is involved on the morning of the Cole Classic.

“The day of the Cole Classic starts early. I’d say some of the crew would start arriving here at around about 4:00 AM. All of the surf lifesaving, the IRBs, and the rescue boats are prepped the day before, but then the team is down here super early in the morning” said John.

“We’re moving stuff around, inflating about 15 of the massive marker buoys that we have out on the course. We’re checking anchors, we’re putting signs up, we’re moving all the registration packs downstairs for all the swimmers to pick up, which is about 1,100 T-shirts and 300 volunteer T-shirts. We’re also setting up the water safety components, so the swimmer support, and the rash vests that all water safety crew use.”

“6:30 AM is showtime, that’s when the registration opens up, the swimmers will start filing in. It is really action-stations.”

“So, the morning of the Cole Classic is great. There’s a buzz in the air and we all look forward to the day. So personally, what I get out of the Cole Classic is a real sense of achievement,” said Reece.

“The physical build up to it and the swim is great, there’s a rush of endorphins afterwards as you try to get the best out of your body, but beyond that, it’s bigger than that. We’re raising money for Breast Cancer Trials this year, and it’s just great knowing that people are willing to support the fundraising that you do leading up to the event.”

“As well as that, after the swim we all get together, we reflect on the swim and what we’re raising money for. We have a bacon and egg sandwich and just get together as a swimming team.”

“So, we do a bit of a roster, but we normally get there about 6:30 AM and we set up on the Manly Ferry side. We’re just directly behind the surf club. So we set up our tent, barbecues, everything. We go get our tags, and then we come back to the tent, and that’s about it,” said Stephen.

“And then it’s just like herding cats. We make a big announcement, so everyone comes, collects their t-shirts, and there’s swimmers that we provide for everyone. And then we then go to the surf club, leave our clothes there. And then, as I say, we do the walk of shame between Manly Surf Club around to Shelley Beach. And then most years, except for two or three, we’ll swim back into Manly.”

breast cancer trials cole classic team jow 240204 0540 | 4

breast cancer trials cole classic team jow 240204 0577 | 5

Pictured: The ‘Walk of Shame’ from the Fugen Tent to Manly Beach.

“And then we go from Manly. We all finish at different times depending on what wave we’re in and how everyone goes, and then we all make our way back to the tent and there’s a barbecue on for everyone.”

“So, we have a great barbecue, the banter’s going everywhere and then there has been known to be swapping of tags. So, one of our slowest swimmers, Flitty, The White Whale, he calls himself, swapped with me one time and a blind 90-year-old beat me home in a one kilometer swim. But anyway, that’s all part of the banter.”

“We won’t admit it, but there is definitely some competition in the office. There’s some young blood in the office now that are sort of chomping at everyone’s feet to try to get the fastest swim. A few years ago, one of the site managers actually swapped the race tag, the clip that goes on the swimmer, with someone else who was faster,” said Reece.

“So, when he crossed the finish line, it said that he finished about 10 minutes quicker than he actually did. So, there’s, there’s a bit of banner there. There’s a lot of fun that goes on.”

We spoke to members of the Fugen Constructions team on race day to hear their thoughts about the event and raising funds for breast cancer research.

“I’m really excited, this is I think my 15^th year of doing the Cole Classic with Fugen so really excited to be here today.”

“I’m feeling pretty good, excited, looking forward to it. It’s my first one, so I think it’ll be good. Everyone’s in a pretty good mood and I think based on a few years ago, I hear some of the boys talking about the barbeque, so it seems like a great day.”

“I’m feeling pretty good. High spirits. We’ve got a big team this year, which is good, everyone sticks together.”

“So, my training plan has involved swimming at the club on a Saturday morning, and the odd swim on Sunday morning. If I make it out of the water at the other end, I’ve done well.”

“We’re feeling great! We’re excited and it’s great to be here with a big bunch of people. I’m hoping to finish under 20 minutes if we can if all goes well.”

“My training has pretty much been having some wine over Christmas and a little ocean swimming. That’s been the training. So, we’ll be right to do it, but we haven’t busted a gut to do it because we can both swim, so we’re fine. We’re just here to have a bit of fun. We’re not really worried about the time.”

“My favourite part of the day is the community. It’s just marvelous. You get out of the water and there’s people cheering you on and then this marvelous barbecue that we have at the end here, catching up with people that we saw last year, so that’s my favourite part of the day.”

“I think it’s a fabulous fun time! I’m an okay swimmer, I’m not a really good swimmer, but even for those of us who aren’t fantastic swimmers, it’s a fabulous day, really, really good fun.”

“It’s community gathering and all being part of a very worthwhile fundraising cause. Steve Flannery who organises this each year, has a different charity each year and it’s always great. But Breast Cancer Trials I think is something that’s very special to Steve, and a lot of us here.”

The Fugen Rack Pack raised an incredible $78,907 for BCT, a testament to the commitment, generosity, and comradery of their community. We cannot thank them enough for their tremendous effort and the impact they will have on the lives of those facing breast cancer.

breast cancer trials cole classic team jow 240204 0859 | 6

Pictured: The Fugen ‘Rack Pack’ Team.

“My name’s Megan from Breast Cancer Trials. For those of you who don’t know, Breast Cancer Trials is one of the leading breast cancer research organisations in the world. We’re dedicated to finding new treatments and better research strategies to save lives from breast cancer.”

“Over the past 20 years, deaths from breast cancer have actually fallen 30 percent and that’s because of our research program. But unfortunately, we still have a long way to go. Today, 57 people will be told they have breast cancer.”

“That’s why every single one of you is so crucial and important. The $70,000 you have raised for Breast Cancer Trials is going to make a huge difference to our research program, so from the bottom of our hearts, thank you all, your friends and family, and everyone who donated. This is a fantastic effort.”

Our life-saving breast cancer research is only possible thanks to the continued generosity of our supporters. Please help continue this vital work by making a donation today. Find out more about how you can become a Pink Champion!

GIVE TO RESEARCH HELPING WOMEN LIKE MADELAINE

Make a donation today

Latest Articles

14/07/2025 – Breast Cancer General

PALB2 Gene

11/07/2025 – Clinical Trial Publications

Treatment Delays Progression of Aggressive Breast Cancer

ASCO 2024: BREAST CANCER RESEARCH SUMMARY

A summary of the key breast cancer research presented at the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting.

American Society of Clinical Oncology (ASCO 2024)

The American Society of Clinical Oncology (ASCO) annual meeting is one of the world’s largest and most renowned cancer conferences, bringing together leading cancer researchers, including those from Breast Cancer Trials, to discuss the latest advancements in treatments, clinical trials research and cancer care.

The following is a summary of the key breast cancer clinical trials research results presented at ASCO 2024.

CHARIOT Clinical Trial

The CHARIOT clinical trial is a pioneering study from Australia developed by BCT researchers. It looked at a new way to treat early-stage triple negative breast cancer resistant to initial treatment with chemotherapy.

The trial tested a combination of two immunotherapy drugs (nivolumab and ipilimumab) with a standard chemotherapy drug (paclitaxel) before surgery. The aim was to see if this combination could safely stimulate the body’s immune system to destroy the cancer cells.

The trial also investigated if continuing with one of the immunotherapy drugs (nivolumab) after surgery could keep the immune system active to wipe out any remaining cancer cells. 34 patients from eight different institutions in Australia participated in this trial, which was led by BCT Board Director Professor Sherene Loi.

Researchers found that patients who had no signs of cancer in their breast and lymph nodes after surgery were less likely to have their cancer come back and had a better chance of survival. Notably, all the patients whose cancer showed an increased presence of a protein called PD-L1, or had a high number of certain immune cells (TILs), were alive and free from breast cancer three years later. This comes with a significant risk of mild to moderate lung inflammation from immunotherapy.

This suggests that the treatment approach tested in the CHARIOT trial could be a promising option for patients with this type of cancer, potentially leading to better outcomes and longer survival. However, more research and follow-up studies are needed to confirm these results and determine the long-term effectiveness and safety of this treatment approach.

Explore the CHARIOT clinical trial results here.

Destiny Breast 06

The Destiny Breast 06 trial is a groundbreaking study that brings new hope for patients with hormone-positive advanced breast cancer. This study looks at a specific group of these patients with low or very low levels of a protein called HER2. The trial is focused on testing a drug called trastuzumab deruxtecan (T-DXd), which is designed to specifically target cancer cells and cause less damage to healthy cell, on patients whose cancer is not responding to standard hormone therapy.

The results of the trial were promising. Patients who were treated with T-DXd saw their tumors shrink significantly and had more time before their cancer progressed compared to those receiving standard chemotherapy.

While T-DXd was effective, it was more likely to cause side effects compared to standard chemotherapy. Notably, moderate to severe lung inflammation can occur and needs to be monitored for closely.

These findings represent a significant step forward in the treatment for hormone positive, advanced breast cancer as these patients could never be treated with HER2-targeted therapy in the past.

ctDNA Results for MonarchE

The MonarchE trial looked at how a drug called abemaciclib, when used with standard hormone therapy, could help patients with early-stage breast cancer who are at high risk of the disease coming back.

One of the ways the researchers checked how well the treatment was working was by using a blood test called circulating tumour DNA (ctDNA) testing. This test finds DNA from cancer cells that have entered the bloodstream, allowing doctors to track the presence and quantity of breast cancer cells in the body.

The ctDNA results from the MonarchE trial were presented by Professor Sherene Loi. It showed that patients who had the combination of abemaciclib and hormone therapy had less ctDNA in their blood compared to those who had hormone therapy alone. This suggests that the combination treatment was more effective in reducing the amount of cancer cells in the body.

The use of ctDNA testing may be able to diagnose the return of cancer earlier in high risk breast cancer patients after surgery. However, more research is needed before we can show that ctDNA testing can guide treatment decisions if signs of cancer DNA is identified.

Breast Cancer Trials is using ctDNA testing in the CAPTURE clinical trial.

Exercise for Cancer Related Fatigue After Early-Stage Breast Cancer Chemotherapy

This study looked at how exercise can help with tiredness (also known as ‘cancer-related fatigue’) in patients who have finished chemotherapy for early-stage breast cancer. The researchers wanted to find out the best ‘dose’ of exercise to reduce this tiredness. This could include things like how often, how long, and how intense the exercise sessions should be.

Before starting chemotherapy, patients with breast cancer were walking for about 40-60 minutes a week at a slow pace, or 20-30 minutes a week at a faster pace.

The researchers found that patients who increased their walking to 111-162 minutes per week at a slow pace, or 54-108 minutes at a faster pace, were 43% more likely to see a big drop in their tiredness. This was true both before chemotherapy and one month after chemotherapy.

These results are important for designing exercise programs to improve the quality of life for breast cancer survivors who feel tired after chemotherapy. Knowing the best ‘dose’ of exercise can help doctors give exercise advice that’s tailored to each patient’s needs.

The RxPONDER Study

Menopause status can inform cancer treatment selection, but knowing when a woman is in menopause can be difficult to determine.

Anti-mullerian hormone (AMH) is a hormone produced by the ovaries that can indicate ovarian reserve and function, with lower levels found in post-menopausal women.

Researchers analysed data from the previously published RxPONDER study and found that premenopausal women with invasive breast cancer who had low levels of AMH, benefitted less from chemotherapy in addition to endocrine treatment, compared to women with medium or high levels of AMH.

Researchers found that AMH was a stronger predictor of chemotherapy response than self-reported menopause status, age and serum levels of other hormones associated with ovarian functioning.

This information could potentially refine treatment decisions, helping to identify which premenopausal women can be spared from unnecessary chemotherapy.

QoL Data from the INAVO-120 Trial

Updated results from the phase three INAVO-120 trial, showed that inavolisib plus palbociclib and fulvestrant improved progression free survival of patients with PIK3CA-mutated, hormone-receptor (HR) positive, HER2-negative metastatic breast cancer.

This triple combination treatment is a promising new treatment option for patients, which halved the risk of disease progression or death, and the time to next treatment, compared to placebo, palbociclib and fulvestrant.

Patient-reported outcomes data suggest patients receiving inavolisib in addition to fulvestrant and palbociclib experienced a longer median time to worsening in pain severity and maintained day-to-day functioning and HRQOL [health-related quality of life] while on treatment with little increased treatment burden.

Impact of Endocrine Therapy in ER-Low Breast Cancer

New research indicates that there may be a survival disadvantage if oncologists omit adjuvant endocrine therapy for patients with a diagnosis of breast cancer, who have low levels of estrogen receptor (ER) expression or ER levels 1-10%.

The retrospective study used data from 354,378 patients with stage I to III ER-positive breast cancer identified in the National Cancer Database (NCDB) in the United States. The NCDB began listing ER status as a continuous variable in 2018. So this study included patients registered in the database from 2018 to 2020.

Overall, 10,362 or 3% of ER-positive breast cancers were classified as ER-low. Of these, 68% were progesterone receptor (PR) negative and 67% were HER2 negative. The majority (77%) of patients were treated with chemotherapy, and these patients formed the study cohort.

Adjuvant ET was omitted in 41% of patients with ER-low status. Researchers found that in this cohort, there was a 25% increased risk for death associated with omission of endocrine therapy despite receiving chemotherapy.

The GEICAM/2003-11 Trial

Triple negative breast cancer (TNBC) has a higher risk of relapse than other breast cancers. Patients with early-stage TNBC are typically treated with surgery and chemotherapy, and sometimes radiotherapy.

Despite effective treatments with neoadjuvant and adjuvant chemotherapies with anthracyclines and taxanes, the recurrence rate for these patients is high. Up to 10% of those with stage I disease will relapse, as will 15-20% of patients with stage II disease, and 25-50% of those with stage III disease. With such high recurrence rates, patients and doctors need better treatment options.

The GEICAM/2003-11 clinical trial explored whether extending treatment with six months of capecitabine after completing standard chemotherapy, improved disease free survival of patients with early TNBC.

This study failed to show a statistically significant increase in disease free survival by adding capecitabine to standard chemotherapy in patients with early TNBC. However, extended treatment with adjuvant capecitabine did significantly improve both disease free and overall survival in a subgroup of patients with a non-basal like phenotype.

Patients are not currently differentiated in basal-like and non-basal like phenotypes and all TNBC is treated the same way. So researchers are now planning to look at the immunohistochemical and genomic characteristics of the patients, to help identify which subgroups of patients with TNBC will benefit from the addition of capecitabine.

YOUR DONATION CAN HELP UNCOVER BETTER TREATMENT OPTIONS

Support Breast Cancer Research

Latest Articles

14/07/2025 – Breast Cancer General

PALB2 Gene

11/07/2025 – Clinical Trial Publications

Treatment Delays Progression of Aggressive Breast Cancer

NAVEENA’S STORY: TRIPLE NEGATIVE BREAST CANCER AND NAVIGATING TREATMENT SIDE EFFECTS

We spoke with Naveena about her breast cancer diagnosis, the long-terms side effects from her treatment, and how she is working to make a difference to the lives of those who have been diagnosed with breast cancer.

Naveena Nekkalapudi is a member of the Breast Cancer Trials Consumer Advisory Panel, where members provide a patient’s perspective in the development of trials and the conduct of our research program. Naveena was diagnosed with stage 3, grade 3, triple negative breast cancer on Christmas Eve in 2014, after finding a lump in her breast during a self-examination.

Due to the long-term side effects from her treatment, Naveena is unable to return to full time work. However, she is still working part time and trying to make a difference to the lives of other people who have been diagnosed with breast cancer.

“Life before breast cancer was very different. I worked in several industries, and I was a bit of a workaholic. So, I started life in the dairy industry because I’m a dairy scientist by trade. I then worked for the public trustee, another organization, funds management, and finally for a health insurer.”

“I was the head of strategy there when I got diagnosed. And I was unable to return to work because the treatment I received did a lot of damage. So now I work part time, but I do a lot of stuff in the health system space.”

“I’m trying to make a difference for people who’ve been diagnosed after me, and I have all this skill set but I can’t work formally anymore so I want to use that skill set along with my lived experience to actually make a difference.”

Listen to the Podcast

How did you find out that you had breast cancer?

“So, I’d found a lump, but I put it down to being a cyst because there was an FM radio station that used to talk about checking your breasts on the first day of the month. This was after Kylie Minogue was diagnosed.”

“And every so often I would do it, and I found a lump. But then I googled it, which was a mistake now, in hindsight. And it said that it’s most likely a cyst, and to check it at different times of the month because of hormonal changes in your body.”

“So, I checked it a couple of weeks later and I couldn’t feel it. So, I just put it down to being a cyst and ignored it. Then over time, it started sticking around a bit more. It wasn’t coming and going like it used to. And because I’d made it a cyst in my brain, I didn’t worry about it. But then I felt my lymph node in my armpit, and thought that’s a bit weird, but I’m feeling great at the moment, maybe I just have a mild infection. It’s nothing, it’ll go away.”

“And it kept growing, and I developed this cough. Which later turned out to be nothing. But I thought a cough and inflamed lymph node must be something, so I thought I should go to the GP. Went to the GP and I explained how I had a cough and inflamed lymph node, but also this lump that used to come and go, but it’s sticking around.”

“My GP had a feel and said that she thought the lump and the lymph node might be connected. And that was the first inkling that there might be an issue. And then she gave me a referral for a mammogram and an ultrasound, and I had that done on Christmas Eve because I just wanted to get it out of the way, because I was convinced that it wasn’t going to be anything anyway.”

“So, half an hour after I got home, I got a phone call from my GP apologizing for breaking the news over the phone, but basically saying it’s bad news. It’s a tumor, and I just remember the white noise rushing past my ears. I was just thinking, ‘what?”

“I remember asking if it was benign or malignant, and I was trying to kind of try and steer it down the ‘it’s nothing major’ path. But she said, “I think it’s malignant and you’re going to have a pretty crappy year next year.”

“And I knew it had spread because I had felt the swollen lymph node. That was the reason why I was kind of extra worried because I thought it was spreading, and I knew the lump had been there for a while, because I’d ignored it, knowing it was there. So, it took two weeks to see a specialist, because it was a Christmas break.”

“And the two people I thought of straight away were Jane McGrath and Belinda Emmett, who were famous Australians who had died from breast cancer.”

“And then I had to give myself a mental slap and go how many people get diagnosed a year around the world? It must be in the millions. And they’re all fine, but you’re thinking about the two people who died, and that made the news because they died. I’ve got to calm down. I know the Australian health system is good, and we found it, so let’s just deal with it.”

“Every time I felt pain somewhere, I thought it was spreading, and it’s a tumor in your knee now, and it’s a tumor in your brain now. But because I had no experience with cancer, to me it was a death sentence.”

What was your biggest fear during this time?

“The first thing that went through my head was, I’m going to die. Because I thought it had been around for a while, so it had some time to spread, and it might be terminal.”

“I’m a carer for my parents, and I’d just bought an eight-week-old puppy, two weeks prior to that. And I just kept thinking I’m not going to see my puppy grow up. Who’s going to look after my parents? And all sorts of things, it was very melodramatic now looking back. But it was all going on inside my brain.”

“I didn’t show any emotions externally because I didn’t want to alert people to it for a couple of reasons. One, I wanted them to have a good Christmas and New Year’s because who knew what was coming and they might have bad ones for the next few years, if not forever, if I died or something.”

“So, I thought let them at least sleep for as long as I can let them have peace. But once I have to deal with it, they’ll know. The other reason being if someone said to you, I’ve got cancer, you’ll be saying how bad is it? What’s the treatment plan? Will you be okay? And I had no information.”

“And so, I thought rather than all of us sitting there not knowing, let me just deal with it and I can then I can work on my communication plan to all my stakeholders about what comes next.”

How did your family react when you told them?

“They were devastated. My poor family. My brother, who’s a GP, came down from Brisbane, because I live in Melbourne, and he helped me break the news to my parents. And we broke it to them on the Saturday, and I was having surgery on the Monday. And, in hindsight, I wouldn’t do anything differently because in a way, they’re just swept along on the journey. It doesn’t give them time to think at that stage.”

“Of course, once the surgery is done and you have some downtime before you start the next treatment, which is chemotherapy, I’m sure they were very upset. It’s hard, the whole process, but for me I would rather have cancer again than have to break it to them again because that was really, really awful.”

“So, my type of breast cancer at the time only had three options of treatment. One being surgery, the other being chemotherapy and then radiotherapy. The other subtypes have things like endocrine therapy and so on.”

“So, I started with surgery. They’ve changed it around now and I think now is a better way of doing it. But at the time, surgery went first. And so, they removed the lump, and they removed all the lymph nodes in my armpit because they thought four or five of them were affected.”

“It turned out only one was affected, but I lost all my lymph nodes, and that means that I’m susceptible to things like lymphedema. I then had chemotherapy for six months, and then radiotherapy, which was 30 rounds, which works out to be six weeks. It’s every day, Monday to Friday.”

“With the surgery, the first issue I faced was scar tissue. They give you exercises at the hospital, and there’s a physiotherapist who comes around and says, here’s a list of exercises. Do them, but don’t push yourself if it hurts. So, I didn’t push myself because it was hurting. And what it meant was that I had this thick almost guitar string, from under my breast up through my shoulder all the way down to my wrist, which was limiting my movement.”

“I couldn’t lift my arm past my shoulder. And apparently that’s called cording, and I had to go and see a special physiotherapist to break it. And they break it by basically digging their fingers into your flesh, where the scar tissue is, and pushing down and massaging it, and it’s very painful.”

“In terms of chemotherapy, most people think the extent of it is hair loss and nausea, but you actually don’t get nausea anymore because they give you steroids, but that means you’re hungry and you put on weight. It’s the opposite problem to what you think it is. And your family members overfeed you because they think you’re dying, and that’s the way of them showing you love.”

“But also, there were things like when your hair falls out, your scalp hurts. You don’t realize that, but it’s painful, because your scalp becomes very sensitive. You get ulcers in your mouth, you can either have constipation and or diarrhea, you get joint pain, your fatigue is bad. And with the radiotherapy, you get burnt basically, and some people end up with blisters. I fortunately didn’t, but you get this layer of skin that’s basically dried up and burnt and it itches, and it hurts at the same time, which is a weird feeling.”

“And there’s other people who have extra therapies, like endocrine therapy and Herceptin and so on, and they come with their own side effects as well. But in my case, those are the things that I had, and with the side effects, the other problem is, you think you can put up with it because it’ll only last as long as the treatment lasts, and then you can move on. But it doesn’t. It keeps going. And somebody said to me, it takes you two years to feel human again. And they’re mostly right. It’s taken me longer, but it’s quite a long process of recovery.”

“So, I look at my life now and I used to be a workaholic. I probably still am in some ways, but I used to do stuff for my head and now I do stuff for my heart. And trying to make somebody else’s life better gives me purpose, and it makes me utilise the experience I gained while I was employed, with the experience I’ve gained through the cancer treatment process.”

How are you feeling now?

“So, in my case one of the chemotherapies damaged my nerves, so I’ve ended up with chronic pain in all my major joints, which is why I’m unable to work full time anymore. But what I’ve done is I’ve used that as motivation to try and improve the quality of life of other cancer patients because there’s ways of actually being more targeted now.”

“There are some breast cancer patients for whom chemotherapy is of no use. And so, my advocacy around that is, if you don’t have to use it, one, it saves costs, but it’s actually saving them a lot of agony and pain and long-term side effects and a reduced quality of life.”

Before your diagnosis, what did you think about breast cancer?

“There was no cancer in our family, so I didn’t really know much about it other than there being a bunch of famous people who got diagnosed, and of course you know it’s in the breast. And you see people lose their hair and look unwell.”

“But then the moment treatment finishes, voila, they’re back to being normal again. But the depth of information and knowledge you gain when you’re going through it is endless, and you realise that breast cancer is different to bowel cancer, which is different to lung cancer.”

“They’re all very different in how you feel, and they’re all very different in the treatment process. There are also different subtypes of breast cancer, which have different therapy types. You go through the treatment and then you realise that unlike other chronic diseases, the breast cancer treatment or cancer treatment actually makes you feel worse.”

“So, you need a long recovery time at the end of it. I still remember I was filling out the form at work to get time off, and I filled it out and I was like ‘okay I’m going to have six months of chemotherapy, six-weeks of radiotherapy, and I think I’ll finish up mid-September. So, I’ll take a couple of weeks off, and then I’ll be back in October.”

“And Human Resources had filled out the same form at work, and the human resources person had given me time off till February the following year. And I’d forgotten that you need time to recovery from the treatment, and I’d forgotten about how bad the treatment makes you feel.”

“I think the other thing I learned is before I went through the treatment, I thought I would go back to who I was. I would take time off, have my treatment, finish treatment, and then go back to the person I used to be. And the thing is, nobody does. You’re changed, both mentally and physically.”

“So, there’s so much information and experience that I’ve gained going through it. Someone once said to me, they napalm you and see what grows back, and they’re right. You feel like they’ve basically slammed you, and you come crawling back and try and rejuvenate to being who you used to be.”

Why is it important to try and find kinder treatments with fewer side effects for breast cancer patients?

“I think it’s important because so far I think the focus of treatment has been to save the person’s life, which is great, we really appreciate that and the patient is all for having their life saved, but what happens is you then have to live with the consequences of the treatment, and the side effects that go on for life.”

“And once upon a time we had a very blunt instrument of surgery to remove the entire breast. And then we started looking at other ways of treating breast cancer and stopping it coming back. So, we added radiotherapy and chemotherapy, and now we’ve added endocrine therapies and immunotherapies and so on.”

“So, we’re getting better at realizing what works, and getting better at finessing, but we’re not there yet in the sense of applying it to the wider population. And so, I think it’s necessary to start being more finessed in how we treat patients because some of us will live for 30, 40, 50 more years with the consequences of the treatment that we’re given.”

If you could share a message to the thousands of people who donate to Breast Cancer Trials, what would you say?

“Firstly, I want to say thank you to them because the money that they donate goes towards cancer research, and it saves lives. Clinical trials are critical because we need to get better at finessing things, and we also haven’t dealt with the problem entirely.”

“Breast cancer has a 92 percent survival rate, but it differs for the different subtypes. If you take it on average, there’s still 8 percent of people dying. One in seven women get diagnosed with breast cancer. And it could be you, or your family member, or a friend. And it takes a toll on the community.”

Putting money into clinical trials research helps the end outcome, and it helps improve outcomes for people who’ve got breast cancer. I would also love it if we had no more deaths from breast cancer. I know it’s a pie in the sky kind of ambition, but while people are working on that, my focus is very much on improving quality of life outcomes for people who’ve been diagnosed with breast cancer, and getting more finessed on how we deal with it.”

“And so that’s why I joined Breast Cancer Trials as a consumer on their Consumer Advisory Panel because I want researchers to be aware of the issues that people who’ve been treated for cancer face.”

Our life-saving breast cancer research is only possible thanks to the continued generosity of our supporters. Please help continue this vital work by making a donation today.

GIVE TO RESEARCH HELPING WOMEN LIKE MADELAINE

Make a donation today

Latest Articles

14/07/2025 – Breast Cancer General

PALB2 Gene

11/07/2025 – Clinical Trial Publications

CHALLENGES IN VERY EARLY BREAST CANCER WITH PROFESSOR BRUCE MANN

Listen to the Podcast

How important is interdisciplinary collaboraton in treating patients with very early breast cancer?

What are some of the barriers of challenges that exist in ensuring patients are receiving timely care for their breast cancer?

Support Us

Latest Articles

SIGN UP TO RECEIVE RESEARCH UPDATES FROM BREAST CANCER TRIALS

A MEDICAL ONCOLOGIST AND RADIATION ONCOLOGIST DISCUSS OLIGOMETASTATIC BREAST CANCER

What are some of the current standard treatment approaches for oligometastatic breast cancer?

Listen to the Podcast

What are some of the primary goals of radiation therapy when treating oligometastatic breast cancer?

How do you determine if a patient with breast cancer is suitable for radiation therapy?

In what ways does personalised medicine play a role in treating oligometastatic breast cancer?

What are your hopes for the future?

Support Us

Latest Articles

SIGN UP TO RECEIVE RESEARCH UPDATES FROM BREAST CANCER TRIALS

BREAST CANCER AND HEART DISEASE

Breast Cancer and Heart Disease: Understanding the Link

Can Breast Cancer Affect Your Heart

Cardiotoxicity

Chemotherapy-Induced Cardiotoxicity

Radiation-Induced Cardiotoxicity

Monitoring and Management

Preventative Strategies

Learn More About Breast Cancer and Heart Disease in Our Online Q&A

Get Support

Practical Support

Emotional Support

Professional Support

FAQs

Can Breast Cancer Cause High Blood Pressure?

Can Radiation for Breast Cancer Cause High Blood Pressure?

Can Breast Cancer Cause Heart Palpitations?

Can Breast Cancer Cause Chest Pain?

Improving Cardiovascular Care

Support Us

Latest Articles

SIGN UP TO RECEIVE RESEARCH UPDATES FROM BREAST CANCER TRIALS

THE OLIO CLINICAL TRIAL WITH STUDY CHAIR DR STEPHEN LUEN

What is the aim of the OLIO clinical trial?

Listen to the Podcast

How prevalent is HR-positive breast cancer?

Why might young women with HR-positive breast cancer have higher rates of recurrence?

What role does the immune system play in trying to make a treatment more effective?

What are your hopes for the future?

Support Us

Latest Articles

SIGN UP TO RECEIVE RESEARCH UPDATES FROM BREAST CANCER TRIALS

OMITTING RADIOTHERAPY MAY IMPROVE QUALITY OF LIFE FOR BREAST CANCER PATIENTS

Support Us

Latest Articles

SIGN UP TO RECEIVE RESEARCH UPDATES FROM BREAST CANCER TRIALS

UNDERSTANDING HOW BMI COULD IMPROVE BREAST CANCER TREATMENT: PALLAS FOLLOW-UP

Support Us

Latest Articles

SIGN UP TO RECEIVE RESEARCH UPDATES FROM BREAST CANCER TRIALS

UNLOCKING PERSONALISED PREVENTION: HOW HORMONE LEVELS GUIDE CANCER PREVENTION IN POSTMENOPAUSAL WOMEN

Support Us

Latest Articles

SIGN UP TO RECEIVE RESEARCH UPDATES FROM BREAST CANCER TRIALS

THE BENEFITS OF DIFFERENCE: HOW TARGETING SUBTYPES OF A DEADLY CANCER COULD IMPROVE PATIENT OUTCOMES

Support Us

Latest Articles

SIGN UP TO RECEIVE RESEARCH UPDATES FROM BREAST CANCER TRIALS

RETHINKING RADIATION IN EARLY BREAST CANCER: PROSPECT TRIAL HIGHLIGHTS

Support Us

Latest Articles

SIGN UP TO RECEIVE RESEARCH UPDATES FROM BREAST CANCER TRIALS

BECOME A PINK CHAMPION FOR BREAST CANCER TRIALS LIKE FUGEN CONSTRUCTIONS

Listen to the Podcast

GIVE TO RESEARCH HELPING WOMEN LIKE MADELAINE

Latest Articles

SIGN UP TO RECEIVE RESEARCH UPDATES FROM BREAST CANCER TRIALS

ASCO 2024: BREAST CANCER RESEARCH SUMMARY

American Society of Clinical Oncology (ASCO 2024)

CHARIOT Clinical Trial

Destiny Breast 06

ctDNA Results for MonarchE

Exercise for Cancer Related Fatigue After Early-Stage Breast Cancer Chemotherapy