A group of more than 100 breast cancer specialists in the U.K. have reviewed the issues related to breast cancer prevention and treatment and drafted a list of critical gaps in breast cancer research, updating a previous gap analysis from 2008.

In an article published Oct. 1 in the journal Breast Cancer Research, Suzanne A. Eccles, PhD, of the Institute of Cancer Research in London, and dozens of colleagues outlined 10 key gaps:

• Understanding the specific functions and contextual interactions of genetic and epigenetic changes in the normal breast and the development of cancer;
• Effective and sustainable lifestyle changes (diet, exercise and weight) alongside chemopreventive strategies;
• Tailored screening approaches including clinically actionable tests;
• Molecular drivers behind breast cancer subtypes, treatment resistance and metastasis;
• Mechanisms of tumor heterogeneity, tumor dormancy, de novo or acquired resistance; how to target the key nodes in these dynamic processes;
• Validated markers of chemosensitivity and radiosensitivity;
• Interactions, duration, sequencing and optimal combinations of therapy for improved individualization of treatment;
• Optimized multimodality imaging for diagnosis and therapeutic monitoring should enable better evaluation of primary and metastatic disease;
• Interventions and support to improve the survivorship experience including physical symptoms such as hot flushes and lymphedema; and
• Clinically annotated tissues for translational research including tumor, non-tumor and blood-based materials from primary cancers, relapsed and metastatic disease

To make progress in addressing these gaps, the authors suggested improving clinical trial methodologies by increasing patient involvement and developing a collaborative infrastructure to support breast cancer research.

"We've known for some time that breast cancer is not just one disease but our understanding has increased enormously in the five years since the first Gap Analysis in 2008,” Eccles said in a release. “We now know that breast cancer cells can have different characteristics, even within the same tumor, and these can also change over time. This makes it much more complex to research and is why we need greater collaboration between multidisciplinary teams and an improved infrastructure, to ensure we are getting the data and tissue samples needed to advance our research knowledge."