Edinburgh scientists receive funding to stop early form of breast cancer becoming invasive

Around 7,000 people in the UK are diagnosed with DCIS every year. It begins in the lining of the milk ducts of the breast, but at this stage, the cancer cells haven’t developed the ability to grow into the surrounding breast tissue. Because it remains contained at this stage, DCIS generally has a very good prognosis.

The treatment usually involves surgery to remove the affected area of the breast. The surgery may be followed by radiotherapy and in some cases hormone therapy. But even with treatment, a small number of DCIS cases can still progress to become invasive breast cancer. Invasive cancer has the potential to also spread to other parts of the body, where it becomes incurable.

However, many cases may never progress and people with low-risk DCIS may not need extensive and intensive treatments they currently receive that can reduce their quality of life. But there is no reliable way to tell apart low-risk DCIS cases that will never progress and high-risk DCIS cases that may develop into invasive breast cancer. This makes it difficult to select the most suitable treatment.

Dr Takanori Kitamura and his team recently found that a type of immune cell, called a macrophage, could be involved in DCIS progression. They found that macrophages making a protein called SIGLEC1 were present within DCIS that later became invasive.

Now, with Breast Cancer Now funding, the researchers want to discover why.

The team will use cutting-edge technology to understand what genes these macrophages rely on and which proteins they make. This knowledge will help them to understand how they communicate with DCIS cells and other non-cancer cells to help DCIS gain the ability to spread and become invasive breast cancer.

Then they’ll investigate mini tumours in the lab, where they’ll study how proteins made by macrophages impact DCIS cells to become invasive.

Finally, they will test if blocking these proteins is an effective treatment to prevent DCIS progression.

Dr Takanori Kitamura said: “Our research will help us understand how the immune system is involved in DCIS progression. This could help us predict which DCIS tumours are likely to become invasive. And it could pave the way for the development of new treatments to prevent progression, ultimately improving outcomes for people diagnosed with this early form of breast cancer.”

Dr Kotryna Temcinaite, head of research communications at Breast Cancer Now said: “Breast Cancer Now is delighted to fund this research that could help to identify patients with high-risk DCIS who could benefit from treatment, whilst also sparing individuals with low-risk DCIS that may never cause any harm from unnecessary therapies that may impact their quality of life.”

Djennah Benaouicha, from Motherwell, Scotland was diagnosed with DCIS last year at the age of 32.

Djennah, an NHS physiotherapist and mum to five-year-old daughter Millie, started regularly checking her breasts after her older sister Nadia was diagnosed with DCIS four years ago.

In February last year, Djennah found a lump. Although her GP referred her quickly to the breast clinic, a series of inconclusive ultrasounds and biopsies meant her diagnosis was delayed by months.

When Djennah went back to the breast clinic, she took her sister Nadia with her - a decision she will be eternally grateful for.

Djennah says: “Nadia assumed I’d already been offered a mammogram, so when she found out I hadn’t, she spoke up and said we’d feel more comfortable if one could be done. The doctors were reluctant because I was under 40 and mammograms can be less effective in younger women due to dense breast tissue, but Nadia pushed - and thankfully, they agreed.”

The mammogram revealed a suspicious area, followed by a second ultrasound that picked up changes in tissue texture. A guided biopsy finally confirmed high-grade DCIS.

“The diagnosis was a shock, but I felt incredibly lucky it was caught early enough to avoid chemotherapy,” Djennah says. “It’s overwhelming to think how different things could have been if we hadn’t insisted on that mammogram and what might have happened years down the line.”

Because both sisters had been diagnosed with DCIS in their thirties, they were sent for gene testing and discovered they both have a rare ATM gene mutation which carries an increased risk of breast cancer.

The risk of Djennah having breast cancer, based on her form of gene mutation along with her also having had DCIS already is now 70 per cent, so she has decided to have a preventative double mastectomy once she recovers from her recent surgery and radiotherapy.

“It’s not a risk I want to take, I’ve got my wee girl to think about,” Djennah says.

Now, Djennah is supporting new research into DCIS and how it may develop into invasive breast cancer.

“I’m fully behind this research,” she says. “It gives me hope that we’re moving toward better treatments and more personalised care. If we can understand individual risk better, maybe fewer people will need to go through surgery or radiotherapy unnecessarily. These treatments are tough, physically and emotionally. It’s reassuring to know scientists are working towards giving people clearer information about their treatment.”

Breast Cancer Now is the research and support charity here for anyone affected by breast cancer. Call their free confidential helpline on 0808 800 6000 to speak to their expert nurses or find out more and donate at breastcancernow.org