AI software that acts as a triage for breast cancer patients

Artificial intelligence that can triage breast cancer patients based on their hormone levels and identify those in need of urgent chemotherapy is developed by British scientists

  • The AI identifies patients that can carry on with hormone treatment for 6 months
  • Patients able to continue hormone treatment don’t need urgent chemotherapy 
  • Researchers say this AI will help prioritise treatment during coronavirus 
  • Here’s how to help people impacted by Covid-19

Software that can determine which breast cancer patients are in the most urgent need of surgery or chemotherapy has been developed by British scientists.

The artificial intelligence algorithm uses data from different studies to identify patients able to go on hormone therapy rather than require urgent surgery.

Scientists created the technology as a way to ensure women get the best available treatment during the COVID-19 pandemic that has seen surgeries cancelled.

It uses data from multiple international trials to pick out those whose tumours are less likely to respond to hormonal drugs and found 5 per cent were at the most risk.  

Software that can determine which breast cancer patients are in the most urgent need of surgery or chemotherapy has been developed by British scientists. Stock image

The AI looks at postmenopausal patients with breast cancer fuelled by oestrogen – which applies to 70 per cent of breast cancer cases in the UK, authors say.

Baroness Delyth Morgan, chief Executive at Breast Cancer Now which helped fund the research, said it was a new and fantastic approach.

She said it ‘could help guide the best possible treatment for thousands of NHS breast cancer patients during the pandemic’ and help best practice globally. 

‘This landmark guidance could now help to identify women that must be prioritised for surgery or chemotherapy urgently, and those that could safely be given hormone therapy to delay further treatment during the pandemic,’ Morgan said.

‘It is a real testament not only to UK science but to the rapid collaboration of researchers globally to help ensure breast cancer patients can get the best possible care while minimising the risks to them at this time.’

Breast cancer is the UK’s most common cancer, with around 55,000 women and 370 men being diagnosed each year, and around 11,500 women dying.

Professor Mitch Dowsett, Head of the Ralph Lauren Centre for Breast Cancer Research, said 85 per cent of patients whose surgery is deferred would be safe to remain on hormone treatment for up to six months.

This leaves 15 per cent who would need to be given surgery or chemotherapy due to the risk of the disease spreading.

‘By accessing unpublished results from clinical trials involving thousands of patients, with colleagues here and abroad we have developed a new way of directing patients’ treatment in this global crisis,’ Dowsett said.

‘Using the data on oestrogen receptor, progesterone receptor and proliferation from the tumour of newly diagnosed patients, our simple new calculator can be used by fellow clinicians worldwide to immediately identify the best course of treatment for about 80 per cent of their patients.’

The software was built at the world famous Royal Marsden Hospital in Sutton and the Breast Cancer Now Research Centre at The Institute of Cancer Research in London.

It organises patients with ER positive, HER2 negative primary breast cancer into three groups based on their oestrogen and progesterone levels at diagnosis.

Around 60 per cent of those classified by the AI have low amounts at diagnosis and so can receive hormone therapy for up to six months – and don’t need surgery now.

Roughly five per cent with large quantities should not be given hormone therapy – but instead should be offered urgent surgery or chemotherapy.

For the remaining 35 per cent it’s recommended they begin hormone therapy. 

They should also be measured for the cancer cells actively multiplying – called Ki67. 

This measurement should be taken after a few weeks of using the hormone therapy to determine the best course of treatment. 

If this is low they should continue hormone therapy for at least six months.

Those with higher levels of oestrogen and progesterone should be considered for surgery or chemotherapy, according to the developers of the AI.

The team – which included scientists in Germany and the US – say the pandemic has led to an international need to reassess the benefits and risks of cancer treatment.

Women most in need of surgery and chemotherapy have to be prioritised to protect staff and patients who may be more vulnerable to infection.

Scientists created the technology as a way to ensure women get the best available treatment during the COVID-19 pandemic that has seen surgeries cancelled. Stock image

‘Crucially, access to testing for Ki67 or imaging will now be needed to help determine whether some women should continue neoadjuvant hormone therapy for longer, or should be given chemotherapy or surgery,’ said Morgan.

‘We hope that patients needing these services can be given access to them to ensure they can receive the best treatment for them.

‘With some cancer treatments being delayed or changed due to the risks of coronavirus or NHS pressures, we need to do all we can to support patients, doctors and multidisciplinary teams to ensure the right choice for each person.’ 

Consultant Breast Surgeon at The Royal Marsden, Peter Barry said it was important as many urgent patients were treated as safely and quickly as possible.

‘This innovative algorithm will help clinicians offer the best treatment for their patients during these unprecedented times,’ he said. 

‘I have already identified patients that would have been deferred to receive NeoET, that may well have been at risk of progression within the six months.’

Grandmother Carole Smith, 68, from Surrey said she was supposed to have surgery in April but this was suspended due to coronavirus.

‘I was surprised when my surgeon at The Royal Marsden called to say that I could have it done a few weeks after my original surgery date,’ said Ms Smith.

‘When you’re told you have cancer in your body you just want it take out, so I was really relieved they called me back. I am so grateful for the researchers making this discovery as I could possibly have progressed if left for a few months.’  

Breast cancer is one of the most common cancers in the world and affects more than two MILLION women a year

Breast cancer is one of the most common cancers in the world. Each year in the UK there are more than 55,000 new cases, and the disease claims the lives of 11,500 women. In the US, it strikes 266,000 each year and kills 40,000. But what causes it and how can it be treated?

What is breast cancer?

Breast cancer develops from a cancerous cell which develops in the lining of a duct or lobule in one of the breasts.

When the breast cancer has spread into surrounding breast tissue it is called an ‘invasive’ breast cancer. Some people are diagnosed with ‘carcinoma in situ’, where no cancer cells have grown beyond the duct or lobule.

Most cases develop in women over the age of 50 but younger women are sometimes affected. Breast cancer can develop in men though this is rare.

Staging means how big the cancer is and whether it has spread. Stage 1 is the earliest stage and stage 4 means the cancer has spread to another part of the body.

The cancerous cells are graded from low, which means a slow growth, to high, which is fast growing. High grade cancers are more likely to come back after they have first been treated.

What causes breast cancer?

A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiply ‘out of control’.

Although breast cancer can develop for no apparent reason, there are some risk factors that can increase the chance of developing breast cancer, such as genetics.

What are the symptoms of breast cancer?

The usual first symptom is a painless lump in the breast, although most breast lumps are not cancerous and are fluid filled cysts, which are benign. 

The first place that breast cancer usually spreads to is the lymph nodes in the armpit. If this occurs you will develop a swelling or lump in an armpit.

How is breast cancer diagnosed?

  • Initial assessment: A doctor examines the breasts and armpits. They may do tests such as a mammography, a special x-ray of the breast tissue which can indicate the possibility of tumours.
  • Biopsy: A biopsy is when a small sample of tissue is removed from a part of the body. The sample is then examined under the microscope to look for abnormal cells. The sample can confirm or rule out cancer.

If you are confirmed to have breast cancer, further tests may be needed to assess if it has spread. For example, blood tests, an ultrasound scan of the liver or a chest x-ray.

How is breast cancer treated?

Treatment options which may be considered include surgery, chemotherapy, radiotherapy and hormone treatment. Often a combination of two or more of these treatments are used.

  • Surgery: Breast-conserving surgery or the removal of the affected breast depending on the size of the tumour.
  • Radiotherapy: A treatment which uses high energy beams of radiation focussed on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying. It is mainly used in addition to surgery.
  • Chemotherapy: A treatment of cancer by using anti-cancer drugs which kill cancer cells, or stop them from multiplying
  • Hormone treatments: Some types of breast cancer are affected by the ‘female’ hormone oestrogen, which can stimulate the cancer cells to divide and multiply. Treatments which reduce the level of these hormones, or prevent them from working, are commonly used in people with breast cancer.

How successful is treatment?

The outlook is best in those who are diagnosed when the cancer is still small, and has not spread. Surgical removal of a tumour in an early stage may then give a good chance of cure.

The routine mammography offered to women between the ages of 50 and 70 mean more breast cancers are being diagnosed and treated at an early stage.

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