The first Breast Cancer UK Prevention Conference was held at Middlesex University on the 21 and 22 of June 2023.
This conference combined two critical themes of breast cancer prevention: the risks posed by environmental chemicals and how lifestyle choices can affect breast cancer risk.
Over two absorbing days, world-leading clinicians, scientists, and researchers from as far afield as the US, Sweden and Switzerland discussed and debated the latest research and science around breast cancer risk factors.
The conference’s climax was the panel discussion of four leading scientists and clinicians. The discussion saw a robust debate on taking the science forward to ensure it meets the criteria needed to drive regulatory and political change.
The audience was left in no doubt of the complexity of the issues being discussed and the passion of the scientists and clinicians before them who have dedicated their careers to preventing breast cancer.
‘This conference is one of the most important in this country this year because what is being discussed here affects everyone. I hope that the outreach from the conference goes far and wide and that, by raising public awareness, political pressure can be applied to change our regulatory systems to improve public protection.’
Professor Michael Antoniou, King’s College London
This conference aimed to discuss and deliberate the work of leading experts in preventative breast cancer science. But to use the conference to amplify this work to a broader audience, including regulators, policymakers and, indeed, the public.
‘Breast Cancer is now the most common cancer in the world, surpassing lung cancer. While there have been many advances in cancer research, we still have so many unanswered questions,’ notes Thalie Martini, the CEO of Breast Cancer UK.
‘Why have incidence rates increased so much in the past 25 years? How many of these incidences of breast cancer result from modifiable factors, and, crucially, why are we not doing more to understand the causes of breast cancer?
‘This conference allows us to bring together the leading minds in the field to share research to help us progress and prioritise breast cancer prevention.’
Meanwhile, behind the science and the scientists sat the personal perspective—a constant reminder of what preventative breast cancer medicine truly means to those touched by breast cancer.
The conference opened with a speech from Professor Carole Anne Upton, Deputy Vice-Chancellor for Global Innovation and Impact at Middlesex University.
Professor Upton spoke movingly about the trauma of her diagnosis and treatment but also explained how learning about the science behind prevention empowered her and gave her back some control over such a traumatic and life-changing experience.
Adding weight to Professor Upton’s testimony were the numerous breast cancer survivors attending the conference, who, throughout the two days, peppered the speakers with pertinent questions about what the science meant for their cancer journey and how they might apply it within their everyday lives.
‘We know we are being exposed to all sorts of environmental chemicals. The question is, how dangerous are they for us, particularly regarding breast cancer? I agree with Professor Vandenberg – at least if we know what we are being exposed to, we can make changes accordingly. I don’t want a reoccurrence of my breast cancer, and the more knowledge I have about what might be a risk factor , the more empowered I am to make the right decision for me.’
Jacqui Loughrey, Breast Cancer Survivor
The first day was focused on the links between exposure to environmental chemicals and breast cancer risk. The Government as well as some scientists have often overlooked this complex area.
Yet, as the speakers shared and discussed the research, it became clear that there is now a substantial body of evidence to convincingly argue just how vital it is that we should all be aware of the possibility of this harm. And that the Government should invest more in this breast cancer research area.
‘I’ve been banging the same drum about chemical exposure and the effect it can have in utero (in the womb) for 17 years. But I’ve struggled to get funding for my work. It’s frustrating to make change happen in the UK, it takes far too long. Until epidemiological research moves on, the question will always be ‘where is the proof?’ Maybe we will never be able to prove conclusively that there is a link between lifestyle or environmental chemicals and breast cancer risk, but you can’t use that as a reason not to act. We must go on the precautionary principle, assume a risk, and act accordingly. Future generations may well look back and say, ‘Why didn’t they act sooner?’’
Dr Michelle Bellingham, University of Glasgow
Keynote speaker Professor Laura Vandenberg of the University of Massachusetts introduced the conference to endocrine-disrupting chemicals (EDCs: chemicals that can mimic natural hormones in the human body). EDCs are a large group of chemicals in thousands of everyday products, from personal care products such as shampoos and suncreams to fire retardants and insecticides.
Professor Vandenberg explained how EDCs that mimic our natural hormone, oestrogen, can still be found in the human body many years after exposure. She told the story of DES, a synthetic hormone manufactured in the US and prescribed in Europe up until 1980 to prevent miscarriage. Women exposed to DES in utero via their mothers were found to have, 40 years on, an increased risk of several different cancers, including breast cancer.
‘Exposure to oestrogens is the number one risk for breast cancer. Data is building that shows exposure to oestrogenic chemicals can contribute to breast cancer risk.
Conferences like this one are so important. They give a voice to scientists who otherwise might struggle to be heard. It is great to meet with your peers, share ideas and cheer each other on.’
Professor Laura Vandenberg, University of Massachusetts
Professor Vandenberg also introduced the conference audience to the concept of the ‘chemical cocktail’. This is the theory that exposure to even low levels of EDCs can be harmful if they are in combination.
Speakers took up this theme throughout the day; Dr Michael Antoniou of King’s College, London, highlighted his investigation into hormone disrupting properties of bisphenol mixtures. Professor Andreas Kortenkamp from Brunel University talked about breast cancer risks and combined exposures to EDCs.
Dr Oskar Karlsson from Stockholm University provided some figures: there are over 350,000 chemicals globally. Most of them have yet to be tested for the effects of interactions with each other and on humans.
Dr Karlsson’s work uses breast cell modelling to investigate the effect of per and polyfluoroalkyl substances (PFAS) – known as the ‘forever chemicals’ for their inability to break down. He found that whilst exposure to PFAS and PFOS (perfluorooctane sulfonate) separately increased changes in our cells, exposure to a combination of these chemicals significantly affected cell growth and cell death.
Many speakers talked about the challenges these complex ‘chemical cocktails’ posed and how they will impact research now and in the future. Researchers may need to look at exposure to many chemicals over a long time. Researchers acknowledged this would be a highly complex process, but this may be possible with some innovation to current research methods.
‘The evidence linking breast cancer to pollutants, etc, is partial. This is partly because the research hasn’t addressed the mixture issues. It has focused on a specific pollutant, and sometimes conflicting evidence exists. We should move away from the perspective that we should investigate just one type of chemical or substance and look at combinations of chemicals. It will be technically challenging, but it can be done. It needs substantial funding to get to a point where it can progress with the regulators and policymakers.’
Professor Andreas Kortenkamp, Brunel University.
Dr Philippa Darbre of Reading University explained how her research showed that residues from many chemicals found in everyday household products, such as deodorants, had found their way into breast tissue. There was, she explained, potential for them to interreact with each other, even at low levels, to damage DNA and increase the growth of cancer cells.
She highlighted the need for research which could measure chemical mixtures in single breast tissue samples, which could mimic experiments with absolute life concentrations and the need to examine the effects of long-term exposure.
‘We are constantly being asked about our evidence. But where is the evidence from the chemical industry that these chemicals are safe? ‘People assume that if you can buy something in the supermarket, it must be safe to use. I would like to see a massive public education policy on chemicals within and around the home.’
Professor Philippa Darbre, University of Reading
There was also positive news across the two days, not least on the many advances in research techniques.
Dr Elisabete Silva of Brunel University introduced her work on the groundbreaking ‘breast on a chip’ technology—a tool which mimics breast tissue. Dr Silva believes that ‘Breast on a Chip’ will improve how she and others study the role and the impact of varying external risk factors in developing the disease without using animal tissue.
Dr Michelle Bellingham, from Glasgow University, spoke about her research work using sheep, which, as she explained, provides a much closer mimicry of human physiology than mice.
Dr Stephen Robinson, from the University of East Anglia, introduced the concept of a potential link between the microbiome and breast cancer. Studies have shown that increased use of microbiome disrupting antibiotics is linked to an increased risk of breast cancer.
Day two of the conference focused on the links between breast cancer risk and a range of lifestyle factors, including diet, weight, exercise, breastfeeding and use of hormones.
The keynote speaker was Dr Michelle Harvie. A world-renowned research dietitian from the University of Manchester and the Genesis Breast Cancer Centre and co-author of the acclaimed ‘2-day diet plan concept’. Dr Harvie set the focus for the day with the question: ‘Can we prevent breast cancer through diet and health behaviours?’
Her talk highlighted the link between weight and breast cancer risk and noted that weight control throughout a lifetime appears to prevent breast cancer cases after menopause. Observational data linked lifetime adherence to physical activity and alcohol guidelines to a reduced risk of developing pre and postmenopausal breast cancer. She also discussed research which indicated that smoking in adolescence, particularly when the breasts are developing, added to breast cancer risk.
‘It appears that the breast is particularly susceptible to carcinogenesis when it is rapidly developing,’ she commented.
Dr Harvie went on to explain that if we implement targeted prevention programs for high-risk women during childhood, adolescence, and early adulthood, we would have fewer lifestyle-related breast cancer cases.
Dr Harvie discussed her study, published in 2019, which demonstrated that overweight women who were informed that they had an increased breast cancer risk were significantly more likely to join and remain in a weight loss programme and to engage in a lifestyle prevention programme. Additionally, the high and moderately at-risk women were more likely to lose weight than women at low risk of breast cancer. Dr Harvie explained this showed the value of educating women about breast cancer risk.
Significant and recent research findings on the association between weight gain and breast cancer risk were shared by Professor Gareth Evans of the University of Manchester. Professor Evans explained figures from the PROCAS (Predicting Risk of Cancer at Screening) Study demonstrated that being overweight or obese in young adulthood was inversely associated with both pre-and postmenopausal breast cancer risk.
Adult weight gain increased postmenopausal breast cancer risk for women with a BMI of less than 23.4 at age 20. It appears that an important factor for breast cancer risk is the amount of weight gained from the late teens in an adult’s life, as opposed to being overweight throughout a person’s life.
‘We know that people with genetic risks can benefit from preventative activities, and the key things they can do include looking after their diet and weight, and being physically active.
But in today’s society, it is not that easy. We can do a lot to help people, but we are simply not implementing it. We badly need to invest in prevention, but, as things stand, it is challenging to secure funding.’
Dr Michelle Harvie, University of Manchester.
Dr James Turner of the University of Birmingham discussed the role of regular exercise and how this supports the immune system to work better in seeking out and destroying pre-cancerous cells. Dr Britta Stordal emphasised the link between breastfeeding and reduced risk and the need to support mothers to breastfeed for as long as possible.
The overall message from the second day was clear. Making specific lifestyle decisions – losing weight, not starting smoking, exercising, or breastfeeding – could reduce the risk of breast cancer. Yet, as the keynote speaker concluded, what could be, in theory, a quick win in breast cancer prevention is being hindered by issues around funding and government focus.
‘Breast cancer is unusual because it is more about weight gain over the adult lifetime than obesity. We need to get that message out there, into schools, as early as possible.’
Professor Gareth Evans, University of Manchester
The conference closed with a panel discussion chaired by Dr Britta Stordal, which included keynote speakers Professor Laura Vandenberg and Dr Michelle Harvie, Professor Andreas Kortenkamp and Professor Gareth Evans.
The theme ‘What policy solutions are needed to progress breast cancer solutions’ provided a rich source of robust debate, not least between the scientists working in lifestyle prevention and those researching environmental chemicals and breast cancer risk.
The message from all the panel members was plain. Despite the enormous strides already made in breast cancer prevention science, significant challenges remain. The current funding gap between research into lifestyle and environmental and chemical risks must be addressed.
Funding is urgently needed for more extensive and effective studies to inform regulators and policymakers better. Scientists from all fields of breast cancer research need to come together to share knowledge and work together to overcome the complexities of researching environmental chemicals and breast cancer risk. Greater public awareness and education will help to move changes forward in the short and medium term.
If you would like to discuss any of the topics addressed at the conference or around breast cancer prevention, Breast Cancer UK would be delighted to hear from you. Please get in touch with our Head of Science, Dr Hannah Moody – [email protected]