Breast cancer prevention
Breast cancer is the second most common form of cancer worldwide, and the Netherlands has the fourth highest percentage of breast cancer cases worldwide. Early diagnosis has made breast cancer less fatal, at least in western countries. But cutting fatalities further requires prevention.
The national breast cancer screening plans in the Netherlands exist exactly for this reason.
The first year of her research was a struggle, she confesses. ‘It is not easy to be a PhD; you work most weekends and evenings. It was challenging and very time-consuming.’ But then her research really got going and her pain and sacrifice paid off.
Phí was researching breast cancer screening techniques. Not just for any woman with a risk of cancer, but specifically for women who have a high risk of getting the disease. Remember Angelina Jolie? In May 2013 she decided to have a preventative double mastectomy after discovering she carried the BRCA1 gene. Her own mother had died of ovarian cancer at the age of 53, so there was also a familial history. Those factors combined meant that Jolie had an 89 percent chance of developing either breast or ovarian cancer.
That’s the kind of high-risk women Phí was working for.
Angelina Jolie
One in eight women in Europe will get breast cancer. But the statistics for women who are high-risk can be much higher. People with a familial history, dense breasts, or who have the BRCA 1 or 2 gene mutation – like Angelina Jolie – all fall into this category. Some researchers say women with the gene mutation can have up to a 70 percent chance of developing breast cancer at some point in their lives. With some – like Jolie – it is even higher.
These high-risk women were already monitored closely. Currently, MRI and mammography are the standard screening options for detecting breast cancer. But the techniques used have their flaws. And – even more problematically – they render different results for different types of breasts. For example, it’s harder to detect cancer in denser breasts – so mammographies tend to yield less accurate results. On the other hand, MRI scans have a higher rate of false positives generally.
Breast density
Phí compared the different techniques to find out how to best protect high-risk women. She found out that using only one technique – as was the common practice – just wasn’t enough. This was an especially flawed strategy to detect cancer in women over the age of fifty. She found that screening regimes should be personalised for women considered high-risk, tailored to their type of BRCA mutation, age, family history, and breast density.
Until that time BRCA carriers were screened with an annual MRI, starting at the age of 25. After thirty they got an annual mammography. Phí’s research showed that mammographies really weren’t needed for young BRCA carriers. Even when they got older, the advantages were limited at best. Now these women are screened with an annual MRI. Only after forty do they get an annual mammography.
It is also recommended that high-risk patients get both an MRI and a mammography. From the age of sixty onward, the screening regimes should be different for BRCA1 and BRCA2 carriers with regard to their breast density.
Prevention strategies
Phí is extremely happy she got to make a real difference. She feels strongly that women at a high risk should receive varied strategies for screening. ‘Only this way can prevention strategies be effective.’
However, she didn’t stop there. There is always more work to do in this field. ‘Research cannot stop; there is no end to scientific research, there is always a new problem to focus on’.