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Research uncovers how breast cancer cells “hibernate” to avoid treatment

Researchers have identified a key mechanism used by cancer cells to evade therapy by remaining in a dormant state

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Scientists have discovered how breast cancer cells can “hibernate” to avoid treatment and “wake up” years later, causing a relapse that is more difficult to treat.

The research, published in the journal Cancer Discovery, has revealed the role of “epigenetics” in controlling how cancer cells can become dormant and suggested a strategy to target it before the cells “wake up”.

Epigenetic changes alter how your body reads your DNA, without changing the DNA code itself.

Patients with oestrogen receptor positive (ER+) breast cancer – which make up 80 per cent of all breast cancers – have a continued risk of their cancer recurring for many years or even decades after their original diagnosis and surgery. To reduce their risk of relapse, patients undergo five to ten years of hormone therapy to target any remaining cancer cells.

The team at The Institute of Cancer Research, London, found that this hormone therapy could, in some cases, play a role in triggering epigenetic changes that alter the state of some breast cancer cells, causing them to become dormant and evade treatment.

The researchers discovered that specific changes in key epigenetic regulators that control gene transcription, including the modification of histone H3 at lysine 9 (H3K9me2), were responsible for this dormant state. These changes remain until the cell “wakes up” and begins dividing rapidly again.

The scientists found that blocking these regulators – by inhibiting the enzymes that catalyse them – prevented the cells from becoming dormant, and killed the cancer cells that were already dormant. They also discovered that in people with low expression of these enzymes, their cancer had a lower risk of coming back years later.

The team studied ER+ breast cancer cells that they tagged with unique barcodes, an innovative way to study millions of cells through space and time. They mimicked hormone therapy treatment on the cells and saw that while most cells died, others became dormant and stopped proliferating.

Using mass spectrometry, the researchers discovered that hormone therapy treatment triggered changes to histone modifications, including H3K9me2, as the cells went into dormancy.

Histone modifications are chemical tags that are added to or removed from DNA, or the proteins DNA is wrapped around. Epigenetic modifications such as this are chemical changes to the three-dimensional structure of DNA, which do not alter the DNA code itself but can control access to genes.

The researchers set out to uncover whether blocking these epigenetic changes could prevent the cells from becoming dormant and evading treatment. To do this, they inhibited the enzyme G9a, which catalyses H3K9me2.

The researchers first tested this on cells which had just been treated with hormone therapy and found that it prevented the cancer cells from entering dormancy – in fact, it killed the cells.

Then, they tested it on cells which were already in a dormant state and found that inhibiting G9a killed dormant cancer cells.

To understand the importance of G9a in people, the researchers studied a cohort of patients with ER+ breast cancer. They found that for those who had low expression of enzymes such as G9a, their breast cancer had a significantly lower risk of relapse over the course of 15 to 20 years.

Professor Luca Magnani, professor of epigenetic plasticity at The Institute of Cancer Research, said: “After surgery to remove primary oestrogen receptor positive breast cancer, patients are given five to ten years of hormone therapy which aims to kill any remaining cancer cells.

“We know that this doesn’t work for all patients though, as their breast cancer can return years, or even decades later. We wanted to better understand why breast cancer does return so we can hopefully find ways to stop it – so people don’t have to live in fear or face the devastating news of a relapse.

“Our research identified a key mechanism used by cancer cells to evade therapy by remaining in a dormant state, hibernating before they ‘wake up’ years later and begin to rapidly divide again.

“I hope our early findings will next lead to research to target these dormant breast cancer cells so that one day, without the need for years of hormone therapy, patients can be sure that their cancer will not return.”

Professor Kristian Helin, chief executive of The Institute of Cancer Research, and a leading researcher of epigenetics and cancer, said the research adds to the growing body of evidence for the role of epigenetic regulation in cancer’s complex behaviour.

“We know that cancer will adapt and evolve to evade treatment, and this study shows how it will lie dormant to hide from treatment,” she said.

“Drugs targeting epigenetic modifications are already in development, and I hope that this research will pave the way to new treatments that prevent breast cancer from returning.”

Dr Tayyaba Jiwani, science engagement manager at Cancer Research UK, added: “Breast cancer survival has doubled in the UK over the last 50 years thanks to better detection and screening, but there are still more than 11,000 deaths from this type of cancer every year.

“Our research has made it increasingly clear that cancer cells can lie dormant in the body for many years before being triggered to reawaken, causing cancer to return. This study uses an innovative approach to analyse the genetics of these dormant cells and gain important insight into the mechanisms leading to dormancy.

“Although at an early stage, the findings reveal potential new targets for the development of innovative treatments that prevent breast cancer from coming back.”

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Apricity Fertility launches new Freeze and Share programme

The Freeze and Share programme offers a solution for women who wish to preserve their fertility

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In response to the growing demand for affordable fertility options and the pressing need for egg donors, the UK virtual fertility clinic Apricity has launched an innovative Freeze and Share programme.

The initiative is designed to make egg freezing more accessible and cost-effective while simultaneously addressing the shortage of donor eggs in the UK.

In recent years, there has been a significant increase in the number of women choosing to freeze their eggs. According to the Human Fertilisation and Embryology Authority (HFEA), the number of egg freezing cycles in the UK has surged by 81 per cent to 2022. Despite this growing trend, the high costs associated with the procedure—typically upwards of £5000—have made it unaffordable for many.

The Freeze and Share programme offers a solution for women who wish to preserve their fertility; by opting to share their eggs, they can substantially reduce the cost of egg freezing.

This act not only makes the procedure more affordable but also provides much longer for donor eggs for those that need them.

Addressing the egg donor shortage

The UK faces a shortage of egg donors, with many patients experiencing long waiting times for a donor. Current statistics reveal that one in six IVF cycles are donation cycles in the UK, yet demand far outstrips supply.

Prospective parents can wait up to two years to find a suitable donor, and for many they decide to travel abroad to places like Spain and Cyprus. This brings different considerations for patients as egg donation in other countries is regulated differently to the UK, with most egg donation being completely anonymous. 

Apricity’s new programme directly addresses this gap by encouraging egg sharing. Participants in the Freeze and Share programme can donate a portion of their eggs to be used by individuals or couples in need, thereby reducing waiting times and helping more people achieve their dreams of parenthood.

“We are incredibly proud to launch our Freeze and Share Programme, which represents a significant advancement in our fertility services,” said Mel Chacksfield, CEO of Apricity Fertility.

“This new service will not only make egg freezing more accessible and affordable to the many women who may not usually have the chance to preserve their fertility, but will also mean we can better support our families and parents that rely on donor eggs to start their families.

“Our commitment to providing personalised care through innovation in the sector continues to drive us forward, ensuring we meet the evolving needs of all our patients”

To be eligible for egg sharing, women will need to meet specific criteria such as BMI, age and ovarian reserve. They will have unlimited counselling throughout the process to ensure they are fully informed and supported from the start.

Women who choose to participate in the Freeze and Share programme will then undergo the standard egg freezing process. A portion of the retrieved eggs will be frozen for their personal use, while the remaining eggs will be donated to Apricity’s frozen egg donor bank.

This mutually beneficial arrangement ensures that participants receive significant financial relief while offering a lifeline to those in need of donor eggs.

For more information on Freeze & Share visit Apricity’s website 

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Endometriosis needs to be taken as seriously as diabetes, says report

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A new report, which called for “urgent” changes in endometriosis care, has said the condition should be taken as seriously as diabetes.

The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report examined the long-standing issues faced by women with endometriosis in the UK.

The study stated that endometriosis should be treated as a chronic condition and taken as seriously as illnesses such as diabetes and bowel disease.

Currently, endometriosis symptoms are treated as multiple isolated episodes, with symptoms often going unrecognised by healthcare practitioners as potentially being endometriosis.

The report recommended that training for healthcare professionals should be improved to recognise the symptoms of endometriosis and that patients should be asked about how the condition affects them beyond just the physical symptoms.

Professor Andrew Horne, director of the University of Edinburgh’s Centre for Reproductive Health, said: “Endometriosis is frequently treated as a series of acute episodes rather than as a continuous, chronic condition. This fragmented care model overlooks the necessity for ongoing, comprehensive management, which is crucial.

“The NCEPOD report recognises the gaps in our current approach and provides important actionable guidance to drive improvements in endometriosis care.”

Emma Cox, CEO of Endometriosis UK, said: “NCEPOD’s report clearly evidences the issues faced today by those with endometriosis, and the recommendations show how improvements can – and must – be made. Implementing these will not only reduce suffering for those with endometriosis, it will also save the NHS time and resources.

“The report comes at a perfect time; we have a new government who have committed to no longer neglect women’s health, and to prioritise women’s health as the NHS is reformed.”

Dr Katy Vincent, associate professor in the Nuffield Department of Women’s and Reproductive Health, University of Oxford, added: “Endometriosis affects all areas of life and the information collected by this enquiry starkly illustrates the challenges that those with the condition experience.

“I am particularly pleased to see that the report highlights the need for holistic, multi-disciplinary care and for a pathway that takes into account the chronic nature of the disease, as these are areas that I have long considered need improvement.”

She continued: “I hope that those who contributed their experiences to the report feel they were heard and that clinicians and policy makers can now take these findings on board to urgently improve care for this common condition.”

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Daye launches workplace app to plug gaps in female healthcare support

The service helps promote health equity in the workplace by providing vital resources to support women’s health conditions

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The award-winning UK gynaecological health company Daye has launched its new workplace app, Daye for Work.

The app can be offered to employees across the UK as a workplace benefit, providing them with much-needed access to services that are often lacking from the NHS and even private healthcare companies.

Women face a widening gap in healthcare provision, with three-quarters saying they cannot access the services they need and 84 per cent reporting not being listened to by a healthcare professional.

Health issues can have a big impact on women’s careers, with three in five women saying a female health condition has affected them in the workplace.

However, support for women’s health is often lacking in the workplace. According to Benden Health, four in ten women have heard derogatory comments about a female employee’s health in the workplace.

As a result, 42 per cent of females admit that they are uncomfortable discussing health issues with their manager.

In addition, more than two thirds of female employees (70 per cent) have found it difficult to deal with periods at work and 64 per cent have faced challenges when experiencing menopause.

Offering support to employees struggling with female health conditions can help attract and retain staff, with 70 per cent of workers willing to change jobs for women’s health benefits.

Daye for Work provides an accessible and personalised service for women and assigned female at birth (AFAB) individuals.

Through the app, employees of businesses who sign up for Daye for Work can access Daye’s Menstrual Health Programme, which provides access to period pain support, plugging a major gap in healthcare provision as it can take years to diagnose conditions linked to menstrual health, such as endometriosis and adenomyosis.

Currently, menstrual pain support is also not offered by major private healthcare providers. Yet period pain can be so severe that nearly a quarter of women (23 per cent) have taken time off work for menstrual symptoms in the last six months, with nine days of productivity per woman lost every year, according to the British Medical Journal.

In monetary terms, women can lose tens of thousands during their careers as they are forced to take time off work.

Daye for Work also offers a Gynae Health Screening Programme, where users can access specialists for gynaecological-related health issues, such as recurrent vaginal infections, which is another service lacking through the NHS and private healthcare companies.

While users can access help from leading specialists through instant virtual appointments, Daye also offers at-home diagnostic tampon tests that can detect vaginal infections and STIs such as chlamydia and gonorrhoea, and soon they will also be able to detect HPV, which is the biggest cause of cervical cancer.

Users receive clear, actionable results via the platform and have prescriptions delivered to their homes.

Daye also offers educational support programmes, including workshops and webinars covering hot topics in female health, and HR policy and internal comms support. Employees signed up through their company get 20 per cent off products on the Daye website.

Valentina Milanova, founder and CEO of Daye, said: “Gaps in women’s health provision are impacting workplaces all over the UK. Female and AFAB staff are regularly forced to take time off while struggling to access much-needed support, advice and diagnosis, hitting workplace productivity and all too often being detrimental to women’s careers.

“Daye for Work will play a vital role in plugging the gaps in female healthcare, offering services that take years to access on the NHS and aren’t available from private healthcare providers.

“Offering such tailored support is transformational for workplace culture, making staff feel valued and understood, while also helping to attract and retain talent.”

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