How Australian-first research and trials are redefining survival for early-onset cancer in the young. Niki Waldegrave reports.
Australia holds a grim record: the highest rates of early-onset breast cancer and bowel cancer in young people in the world.
Now, local oncologists, researchers, clinicians and patients are uniting in landmark research, trials and initiatives targeting its greatest threat to survival – recurrence – aimed at reducing alarming statistics. Bowel cancer is the deadliest cancer for Australians aged 25 to 44, and is the seventh- leading cause of death overall in this age group. Over half of new cases are women. Each year, 1,000 women under 40 are diagnosed with breast cancer – that’s around three every day. Tragically, 79 young women die annually.
‘Can You Tell Me I’m Cured?’
It’s the question Rachel Dear, medical oncologist at St Vincent’s Private Hospital, hears from her patients almost every day.
“I have to look them in the eye and say, ‘I can’t tell you that. I can’t give you any guarantees.’
“That uncertainty is incredibly hard for women to live with.”
Now, as lead and co-investigator of AllClear, the Australia-first research program announced in August focusing on early breast cancer, Dr Dear hopes she’ll finally be able to answer with the words her patients want to hear.
In the last decade, Australian breast cancer diagnoses have increased by 24% – that’s one in seven women and one in 550 men diagnosed in their lifetime, amounting to 58 people a day.
More than 3,300 die each year – nine a day, and one woman under 40 – usually from dormant cancer cells that spread, most often to the bone.
The risk of recurrence ranges from 13% to 41% between five and 20 years after primary diagnosis, depending on the tumour and nodal status of the primary tumour.
Dr Dear explains how once they’re lodged in the bone, these cells can lie dormant for years before reawakening as incurable metastatic disease.
“For too long, research has focused on women who already have metastatic disease, when, unfortunately, it’s generally too late to cure.
“We need to be able to do better for these women.
“AllClear is about getting ahead of recurrence in a diverse population, finding and eradicating dormant cells before they come back.”
The 7 Bridges Walk is celebrating 20 years of raising funds for the Cancer Council on 26 October
Since the National Breast Cancer Foundation (NBCF) started funding in 1994, the death rate from breast cancer has reduced by over 40% thanks in large part to research in prevention, early detection and new and improved breast cancer treatments.
In August, the Garvan Institute of Medical Research and Breast Cancer Trials welcomed NBCF’s first-ever collaborative research accelerator grant – a record $25 million investment.
Its program, AllClear, targets early-onset breast cancer recurrence over five years.
“AllClear’s mission is to identify those dormant cells – what keeps them asleep, what wakes them up – and stop recurrence before it happens,” says Dr Dear.
“They have unique features. They live in a unique microenvironment within the bone. We think identifying and eliminating these dormant cells is the key to curing breast cancer.”
A new trial platform, Activa, will allow researchers to rapidly test new drugs in the neoadjuvant setting with diverse patients of all nationalities diagnosed with early-stage breast cancer.
It includes collaborations with 11 metro and rural hospitals across NSW, including the North Shore’s Mater Hospital, Westmead and Newcastle.
“We’re aiming to recruit more than 400 patients, and this study has been running parallel while we’re setting up the trial platform,” ads Dr Dear.
“We’re doing real-world evidence studies and are excited about providing opportunities for all people, whatever their cultural background, to participate in this research.”
The project unites UNSW, University of Sydney, over 60 researchers, clinicians, and international experts, such as Washington University, which has been collecting bone marrow samples from women with early breast cancer for 20 years.
“We’re all major institutions working together for the same goal,” she adds.
“When I can tell my patients there are no dormant cancer cells left in their body, I look forward to telling them, ‘Yes, you are cured.’”
“IT’S GIVING US LIFE.” BREAST CANCER SURVIVOR LEE HUNT
Former teacher Lee, 73, was diagnosed with Grade 3 HER2- positive breast cancer in 2005.
Following surgery, she undertook an 18-month therapy program, which made her ‘awfully sick, and unfortunately resulted in cardiotoxicity.’
Lee suffered a recurrence 13 years later, explaining: “It’s really a hard journey, mentally, physically, and living with the fear of recurrence.
“We’re planning to go overseas next year, but I won’t book until I’ve had my scans in late October. I’m not an isolated person. This is what it’s like for thousands of us.”
A member of the AllClear project’s patient advocacy and advisory group – the link between patients and researchers – the grandmother-of-one adds: “This research is huge for breast cancer patients and the outcomes will make a real difference.
“It’s giving us life.”
“This research is huge for breast cancer patients”
Breast cancer survivor Lee Hunt
Dr De Lacavalerie says early detection of bowel cancer is crucial for survival
“We eat far more processed food and red meat than previous generations. Awareness and early detection are still our best weapons.”
Dr Penelope De Lacavalerie
Why are more young Australians getting bowel cancer?
Once considered a disease of old age, early-onset bowel (or colorectal)
cancer is the deadliest cancer and the seventh leading cause of death for
Australians aged 25 to 44, and 50.4% are women.
The relapse for early-onset bowel cancer is around 50%, with a 50% chance of spreading to other organs following initial intervention (such as surgery) to remove the primary cancer.
My Sydney Surgeon, Penelope De Lacavalerie, who is a consultant at Northern Beaches Hospital, says: “Bowel cancer can strike young.
“More than nine in 10 survive when diagnosed at the earlier stage, which can mean the difference between life and death.”
At Northern Beaches Hospital, the colorectal surgeon performs cutting-edge robotic and minimally invasive procedures such as laparoscopy.
Her past research collaborations in the prediction of response to chemo-radiotherapy in rectal cancer have led to the prestigious NHMRC Clinical Postgraduate Scholarship.
Also a spokesperson for Bowel Cancer Australia, Dr De Lacavalerie was pivotal in its Never2Young campaign, lowering the national screening age from 50 to 45.
The body is at the forefront of a landmark three-year research project with the University of South Australia, investigating why rates are climbing so steeply in younger Australians.
It aims to identify those at greatest risk of early onset bowel cancer, predict relapses, and deliver more personalised treatment, while cutting back on unnecessary therapies and side effects.
While genetics plays a role, emerging evidence shows lifestyle does too, with those born in the 1990s two to three times more likely to develop bowel cancer than those born in the 1950s.
Dr De Lacavalerie says risk factors include childhood obesity, infections and microbiome changes, potentially caused by things like childhood infections and exposure to microplastics.
“Diet also plays a part as Australians eat far more processed food and red meat than previous generations – often daily.
“Awareness, prevention, and early detection are still our best weapons.”
