What happened?
Patient data was analysed to understand how well different treatments have worked in the past for breast cancer patients after they had surgery. The results were gathered together to create an online tool called Predict which helps breast cancer patients and their doctors today choose a treatment plan together. The tool uses data about the survival of women with similar characteristics and medical history to show patients and doctors the likely benefit of different types of treatment. Then doctors and patients can decide if the benefits of a treatment outweigh the side effects of that treatment and choose the best plan together. Predict is now used as a consultation tool in the NHS.
What have they found?
In March 2020, the researchers published a study on the long term risks of DCIS. They used data on women diagnosed with the disease via the breast screening programme from 1988 to 2014.
The research findings showed that these women have a higher risk of developing invasive breast cancer and of dying from breast cancer when compared to the general population.
In this study, around 9 out of 1000 women diagnosed with DCIS developed invasive breast cancer each year.
In the same group, around 1 out of 1000 women died from breast cancer each year. This was more than expected when compared to the general population.
The likelihood of developing invasive breast cancer and dying from breast cancer continued to increase for at least 20 years after diagnoses of screen detected DCIS.
The study results also suggested that women who had more extensive surgery, such as a mastectomy, had a lower long term risk of invasive breast cancer. A mastectomy is an operation to remove a breast. This is compared to women who had breast conserving surgery, even when radiotherapy was given. Breast-conserving surgery removes the cancer cells while keeping as much of the breast tissue and shape as possible.
Why was the work needed?
Using patient data to understand how well treatments have worked in the past is needed to help doctors and patients make well informed decisions today. Understanding the benefits of different treatments is important so that patients receive the best possible care. Without patient data, it would not be possible to compare cancer treatments and tailor care to the needs of individual patients.
What are the benefits?
The Predict tool uses patient data to provide breast cancer patients and their doctors the best available information about what effect different treatment options might have, displayed in ways that are clear and easy to understand. This helps doctors and patients make an informed decision together about what is right for them, based on the best evidence.
What type of data was used?
Predict was developed using patient data from the Eastern Cancer Information and Registration Centre (ECRIC), which is now a part of the National Cancer Registration and Analysis Service (NCRAS) within NHS Digital. It was also developed using patient data from clinical trials.
What was the legal basis for accessing this data?
NCRAS (and previously the ECRIC) has legal permission to collect patient level data and use it for research to protect the health of the population. This permission was granted to NCRAS under Section 251 of the NHS Act 2006, whilst it was still part of Public Health England (PHE).
This story shows the power of data to confirm that some DCIS can progress to invasive breast cancer, and that survivability of women may therefore be affected. It also shows that mastectomy may be safer than wide local excision or lumpectomy, raising the question of how women will view this.
Who carried out this work?
Predict was developed by the Cambridge Breast Unit, University of Cambridge Department of Oncology, the Winton Centre for Risk and Evidence Communication, Health Data Insight, and the ECRIC.
Last edited: 21 July 2023 12:06 pm
