Cancer
Patients with intermediate-risk breast cancer may safely avoid chest wall irradiation after mastectomy
A clinical trials has shown that patients with intermediate-risk breast cancer had similar rates of ten-year overall survival whether or not they underwent chest wall irradiation (CWI) after mastectomy.
To evaluate the impact of post-mastectomy CWI in patients with intermediate-risk breast cancer, researchers conducted the BIG 2-04 MRC SUPREMO Phase 3 clinical trial.
The international trial enrolled patients from several countries with: breast tumours 50 mm or less across (pT1-2) and one to three positive axillary lymph nodes (N1); breast tumours larger than 50 mm across (pT3) and node-negative disease (N0); or, breast tumours larger than 20 mm but no larger than 50 mm across (pT2); n0 disease, and grade 3 histology and/or lymphovascular invasion.
Of the 1,607 patients available for analysis after exclusions for ineligibility and withdrawals, 808 were randomly assigned to receive CWI after mastectomy (CWI arm), and 799 patients were randomly assigned to omit CWI after mastectomy (no CWI arm); patients also received guideline-concordant axillary node clearance and systemic treatments.
The results shows that there were no significant differences in overall survival between those who received CWI and those who did not, with 81.4 per cent and 82.0 per cent of patients in the CWI and no CWI arms, respectively, alive after a median follow-up of 9.6 years.
Although CWI reduced the risk of chest wall recurrence by over half, the absolute rate of chest wall recurrence was reduced by less than 2per cent, which the researchers explained was a clinically insignificant difference.
When the researchers analysed CWI’s impact in specific patient subgroups, they found that neither patients with n0 disease nor those with N1 disease experienced survival benefits with CWI, suggesting that omission of post-mastectomy CWI may be safe even for patients with lymph node-positive disease.
“While post-mastectomy CWI is the standard of care for most patients with early-stage breast cancer who have four or more positive axillary lymph nodes, its role in patients with fewer positive lymph nodes or node-negative disease remains controversial,” said Ian Kunkler, MA, MB BChir, a professor at the University of Edinburgh and the presenter of the study.
He explained that while guidelines vary, CWI is commonly used to treat patients with intermediate-risk breast cancers, defined as patients with one to three positive lymph nodes or patients who have no positive lymph nodes but whose cancers exhibit other factors that increase the risk of recurrence, such as grade 3 histology and/or lymphovascular invasion.
“This study demonstrates that CWI after a mastectomy has no influence on 10-year overall survival for patients with intermediate-risk breast cancer,” said Kunkler.
“The results are important considerations for shared decision-making conversations between patients and clinicians, as many patients eligible for post- mastectomy CWI may not require the treatment.”
Limitations of the study were the low accrual of patients with pT3, N0 disease and better overall survival than anticipated.
An AI tool could help spot breast cancer risk by analysing how individual breast cells behave when squeezed under stress, research suggests.
Researchers at City of Hope and the University of California, Berkeley, created a microfluidic platform that assesses women’s breast cancer risk at the cellular level.
The platform squeezes individual breast epithelial cells, which line breast tissue, to measure how they deform, recover and behave under stress.
Because more than 90 per cent of women do not have a known genetic predisposition to breast cancer or a family history of the disease, the researchers said the approach could help fill a key gap in risk assessment.
Mark LaBarge, professor in the department of population sciences at City of Hope, said: “For women with a known genetic risk factor for breast cancer, there are things you can do like follow a higher-risk screening protocol. For everybody else, you’re left wondering, ‘Am I at high risk?’
“By translating physical changes in cells into quantifiable data, this tool gives women something tangible to discuss with their doctors, not just risk estimates, but evidence drawn directly from their own cells.”
The researchers developed a machine learning algorithm that identifies and measures cells showing signs of accelerated ageing, generating an individual breast cancer risk score.
They said the platform uses simple electronics that could be easy and affordable to replicate on a large scale.
Lydia Sohn, chair in mechanical engineering at UC Berkeley, said: “Our team isn’t the first to measure the mechanical properties of cells; however, other approaches require advanced imaging technology that’s expensive, cumbersome and has limited availability.
“In contrast, MechanoAge uses computer chips that are simpler than an Apple Watch and ‘RadioShack parts’ that are cheap and easy to assemble, potentially making the device highly scalable.”
About 6 per cent of women who develop breast cancer carry known genetic mutations.
For women outside this group, risk is usually estimated indirectly using population models or measures such as breast density, which can both overestimate and underestimate individual risk.
The researchers said there is currently no non-genetic test that can identify women at higher risk of breast cancer.
Screening mammograms can detect cancer only once it has started to grow, but the MechanoAge platform aims to assess risk earlier by looking for physical changes in individual cells.
Using the platform, the researchers found that breast cells appear to have a “mechanical age” separate from a person’s chronological age, based on how the cells respond to stress.
They said this is the first time mechanical age has been quantified in biological cells.
Sohn said: “We learned that the older the mechanical age, as determined by how cells respond to being squeezed through our microfluidic device, the higher the risk for breast cancer.”
In this type of mechano-node-pore sensing, an electrical current is measured across a liquid-filled channel.
As cells pass through, they disrupt the current, generating measurements about their size and shape. By narrowing parts of the channel, researchers squeeze the cells and then measure how long each one takes to return to its normal shape.
The team found that cells from older women were stiffer and took longer to bounce back after being squeezed.
They also identified a subset of younger women whose cells behaved more like those from older women. These cells came from women with genetic mutations linked to a higher breast cancer risk.
The researchers then refined the algorithm to assign a risk score based on the cells’ measured mechanical and physical properties. They said it successfully identified women with known genetic risks.
The team then used it to compare cells from healthy women, women with a family history of breast cancer, and cells taken from the healthy breast of women with breast cancer in the other breast.
LaBarge said: “With accuracy, we were able to figure out which women were at high risk of breast cancer and which women didn’t seem to be.”
The work grew out of more than 12 years of collaboration between the two labs, combining engineering with cancer and ageing biology.
Sohn said: “It’s a true collaboration. We’ve learned a lot from each other.
LaBarge added: “In my view, this is what happens when you have a real collaboration that develops over a long time. This result is not what we imagined at the beginning.”
An experimental drug slowed triple-negative breast cancer in mice by flooding tumour cells with toxic fats.
Triple-negative breast cancer lacks three common drug targets, making it one of the hardest-to-treat and most aggressive forms of the disease.
The compound, known as DH20931, appears to push cancer cells past their limits by triggering a surge in ceramides, fat-like molecules that place the cells under intense stress until they self-destruct.
In lab experiments, the drug also made standard chemotherapy more effective. When combined with doxorubicin, researchers were able to reduce the dose needed to kill cancer cells by about fivefold.
The drug targets an enzyme known as CerS2 to sharply increase production of these lipids and stress cancer cells. Healthy cells, by contrast, showed lower sensitivity to the drug in lab tests.
While the early results are promising, further preclinical and clinical trials would still be needed to determine the safety and effectiveness of DH20931 in humans.
Satya Narayan, a professor in the University of Florida’s College of Medicine, led the study with an international group of collaborators.
The researchers published their results on human-derived tumours on 21 April and presented their findings on combination therapy at the annual meeting of the American Association for Cancer Research in San Diego.
Narayan likened the drug’s effects to a home’s electrical system handling a power surge.
While healthy cells act like a properly grounded and installed circuit, cancer cells are more like a jumble of mismatched wires and faulty fuses. DH20931 overwhelms cells not with electricity, but with fats.
He said: “When that surge goes into the cancer cells, they cannot handle the amount of power they are getting. The fuses burn out, the cell can’t handle the surge and it dies.”
The compound was developed at the University of Florida in the lab of Sukwong Hong.
Hong, now a professor at the Gwangju Institute of Science and Technology in South Korea, created DH20931 as one of many drug candidates tested for efficacy in Narayan’s lab.
In the study, researchers implanted human triple-negative breast cancer tumours into mice and treated them with DH20931.
The drug significantly slowed tumour growth without causing noticeable weight loss or signs of toxicity in the animals. In separate lab experiments, it also showed activity against other breast cancer subtypes.
In addition to increasing lipid levels, DH20931 triggers a second stress signal by flooding cells with calcium.
Together, these effects disrupt the mitochondria, the structures that produce a cell’s energy, ultimately leading to cell death.
Narayan said: “It does not just follow one pathway but it goes through multiple pathways. It’s a two-hit hypothesis.
“These pathways are common in all breast cancer types and other solid tumours, so we think this drug can be useful not only in triple-negative breast cancer but potentially other cancers as well.”
Cervical cancer elimination in the EU is becoming achievable as HPV vaccination coverage rises, a new report says.
As Europe marks European Immunisation Week 2026, the European Centre for Disease Prevention and Control said progress in human papillomavirus vaccination is continuing across the EU and European Economic Area.
All EU and European Economic Area countries now recommend HPV vaccination for adolescent girls and boys as part of their immunisation programmes, marking a major step forward in Europe’s cancer prevention efforts.
Bruno Ciancio, head of unit, directly transmitted diseases and vaccine preventable diseases at the European Centre for Disease Prevention and Control, said: “The elimination of cervical cancer in the EU/EEA is becoming an achievable goal, thanks to the HPV vaccination programmes.
“The progress we are seeing across Europe demonstrates what can be accomplished when countries invest consistently in effective immunisation strategies.
“We are closely monitoring this progress and actively supporting countries to accelerate uptake and move faster towards cervical cancer elimination.”
According to the report, three EU and European Economic Area countries, Iceland, Portugal and Norway, have reached the 2024 EU Council Recommendation target of 90 per cent HPV vaccination coverage among girls by the age of 15.
Fifteen years after HPV vaccination programmes were introduced in Europe, a growing body of evidence confirms the vaccine is highly effective in preventing cervical cancer.
Large-scale studies from Sweden, the Netherlands and Denmark, as well as other parts of the world, have shown significant reductions in HPV infections and precancerous lesions, which are abnormal cell changes that can develop into cancer if left untreated, alongside falling cervical cancer rates among vaccinated women.
Since 2020, European countries have reported a decreased incidence of cervical cancer among vaccinated women.
Studies from Sweden, Denmark and the UK show that early administration of the vaccine increases its full protective potential.
A Swedish study suggested that vaccinating girls before their 17th birthday reduced the incidence of cervical cancer by 88 per cent.
An additional six-year follow-up found a sustained reduction in cervical cancer risk and a population-level decline in invasive cervical cancer incidence after HPV vaccination.
The report showed that vaccination programmes and health system design are critical factors in reaching high levels of HPV vaccination coverage.
Evidence from across Europe showed that school-based vaccination programmes are particularly effective and tend to reach higher levels of coverage among both girls and boys.
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