The focus of this year’s Breast Health Forum was the progression of cancers and the risk of recurrence, with a clear objective: better understanding for better prevention.

Experts from Quebec outlined recent developments in science, clinical practice, and patient care that are helping to better identify risk factors, prevent progression of breast cancer, and personalize monitoring and treatment approaches.

Here are five key takeaways from this ninth forum.

Did you know that not all tumours are created equal in the face of immune response? Tumours are called hot when they are infiltrated by high levels of immune system cells, which is often a good sign: these tumours tend to respond better to certain treatments, such as immunotherapy and chemotherapy. Conversely, so-called cold tumours, which contain few immune cells, are generally more difficult to treat, and are linked to poorer prognoses. Professor Morag Park’s laboratory at the Rosalind & Morris Goodman Cancer Institute, where PhD student Sandrine Busque works, recently identified a protein specific to these cold tumours. With a clearer understanding of this protein’s role, the research team aims to use it as a therapeutic target, or as a clue to help determine treatment options. The goal is to turn cold tumours into hot ones, which are more responsive to treatment, and in so doing improve success rates for larger numbers of people affected.

Hormone therapy treatments, which block the hormones that drive cancer cell growth, are effective in many women with so-called hormone-dependent breast cancer. However, as Université de Montréal professor and IRIC researcher Sylvie Mader explains, the disease can sometimes become more resistant to such treatments. The cancer cells continue to develop in spite of the hormone therapy. This is known as endocrine resistance.

Fortunately, researchers are making progress. Recent studies have identified certain mechanisms contributing to this resistance, including mutations in hormone receptors and activation of alternate signaling pathways by the tumour. These discoveries open the door to new targeted treatments, such as selective estrogen receptor degraders (SERDs). Unlike other drugs that simply block these receptors, SERDs bind to them and destroy them.

Other options are already available and are being increasingly used; for example, CDK4/6 inhibitors and drugs that target specific signaling pathways like the PI3K/AKT/mTOR pathway. The aim is to bypass resistance and increase treatment efficacy, to improve the odds of long-term disease control.

What if our own immune system could help us better prevent triple-negative breast cancer (TNBC) from recurring? This is the avenue being explored by a team led by Benoit Paquette, a research professor at Université de Sherbrooke. They are focusing on cytokines, small proteins that play a key role in how immune system cells share information with each other. Some cytokines help the body defend itself against cancer, while others, on the contrary, promote its progression. The research team has discovered that radiation therapy—a common course of treatment—can have an impact on cytokine levels, raising or reducing them. Lower levels of pro-cancer cytokines may boost the immune system and be linked to a lower risk of recurrence. By analyzing blood samples pre- and post-treatment, the research team observed that radiation therapy did not affect all study participants’ cytokines in the same way: the decrease in pro-cancer cytokines appeared to be more pronounced in patients who took certain anti-inflammatory drugs during their radiation therapy. These findings could, in time, help improve assessment of women at risk and aid in adapting treatments so as to strengthen immune defences and prevent recurrence. The long-term objective is to develop personalized treatments based on individual patients’ immune responses, so as to more effectively prevent recurrence and slow progression to metastatic forms of TNBC.

It is normal to feel anxious when faced with the prospect of a breast cancer relapse or recurrence. But how do you continue listening to your body without sliding into hypervigilance?

Professor Josée Savard, a psychologist and researcher at Université Laval, shared a number of practical solutions to help people cope more effectively with the fear that the disease may return. Among other things, she explained how fleeing or avoiding worry-inducing thoughts can, on the contrary, magnify anxiety. She suggested alternative strategies, like gradually exposing yourself to difficult thoughts, which helps in managing uncertainty. She also outlined simple questions you can ask to realistically assess your symptoms: Is what I’m feeling new? Is it intense? Is it persistent? What is the probability that it is serious? This is the NIPP method (for Newness, Intensity, Persistence, Probability), a useful tool for distinguishing between symptoms requiring immediate medical attention and those that seem to be harmless. With time, these approaches help cultivate healthy vigilance and keep fear from taking over.

If in doubt, do not hesitate to speak to a health professional. The Quebec Breast Cancer Foundation offers free psychosocial support as well as a new hypnosis program specially designed to help people affected by cancer improve their quality of life after treatment.

You can also call the Foundation’s free peer support helpline, 1 855 561-ROSE (7673), for help in navigating healthcare system resources.

 Led by Marie-Pascale Pomey’s research team, Continuum PAROLE-Onco is a new project designed to provide better support for women affected by breast cancer, from diagnosis to life after treatment. Building on the original PAROLE-Onco program, in which patient advisors provide support and guidance to women who have been diagnosed, Continuum takes things a step further. With Continuum, the goal is to expand on this approach to help women prepare for life after cancer and get frontline care professionals more involved from the outset, to improve continuity of care and ensure smoother post-treatment transitions. Using data from multiple hospitals, the team is also seeking to customize the support approach to individual patients’ profiles. The aim is to provide tailored support throughout the entire oncology care trajectory, while optimizing healthcare system resources.