BIG against breast cancer small Pink Ribbon
 Think BIG News
 26 February 2014
We marked World Cancer Day on February 4th and want to thank you for showing your support on our social media channels!

In this issue of Think BIG News, we meet Dr. Olivia Pagani, Clinical Director of the Breast Unit of Southern Switzerland and responsible for breast cancer at the Institute of Oncology of Southern Switzerland.  Dr. Pagani leads the POSITIVE trial studying the safety of pregnancy after breast cancer that we highlighted in our December newsletter.

We also highlight IBIS II, a study that brings to light a new therapy to prevent breast cancer in post-menopausal women at high risk.
Meet the scientist: Dr. Olivia Pagani
Dr Olivia Pagani
What is your primary area of research, and how will it benefit patients?

I am primarily involved in clinical research for breast cancer in young women, as well as for advanced breast cancer. Right now I am involved in two major studies for young patients. I am one of the trial chairs of TEXT, a study in pre-menopausal women with endocrine responsive breast cancer that aims to discover the best way to give endocrine therapy to young patients to improve their outcomes from the disease.
I am also leading the POSITIVE trial, coordinated by IBCSG within BIG, which addresses pregnancy after breast cancer. This represents the first prospective study trying to determine if pregnancy after breast cancer is safe. This project has been launched with great excitement because we as doctors are often approached by patients about the safety of having a baby after breast cancer treatments. As young patients’ outcomes improve, I believe it is of utmost importance to also address patients’ life projects after breast cancer and improve their quality of life. 

How do you balance your time between research and clinical practice?
I try to balance my responsibilities to patients, research and the Breast Unit, along with making time to teach young doctors who follow and observe my work. I spend two days a week seeing patients; the other three days I spend on clinical research and organizing the breast cancer unit so that it runs smoothly.  
The Breast Unit requires interdisciplinary meetings that include a team of specialists working together for patient-centred care. Ours is the first EUSOMA certified unit in Switzerland, which indicates that it meets the “gold standard” in European breast cancer care. Twice a week, the surgeon, radiologist, radiation and medical oncologists, and dedicated nurse meet as a team to discuss the patient and her course of treatment. This team approach is essential because it allows us to agree on a path for the patient together before the surgery, and to personalize her treatment based on her needs. This level of teamwork can be quite demanding, but it is important for doctors to learn how to work together.

Breast cancer research also includes studies of prevention: a closer look the IBIS II trialDoctor and patient
IBIS II (International Breast Cancer Prevention Study II) is an international clinical trial supported by the BIG and launched in 2003 that focuses on the prevention of breast cancer for women who have passed through menopause (post-menopausal) and who have not developed breast cancer but are considered to be at high risk of getting the disease. Women may be considered to be at high risk for several reasons:  a family history of cancer (breast or ovarian), non-cancerous breast disease, or a pre-cancerous condition such as ductal carcinoma in situ (DCIS).

IBIS II researchers looked at whether a treatment with the drug anastrozole could prevent the development of breast cancer in postmenopausal women who are at high risk.

In total the IBIS II study recruited 3,864 women from 238 different medical centres in 17 countries. Patients were treated for a period of five years. About half of the patients received anastrozole, and the other half received a placebo. This was a randomized study, where neither the patients nor the treating physician knew which treatment was given to each woman.   

Based on the analysis performed after five years, it was reported that among the anastrozole-treated group, 40 women had developed breast cancer. In comparison, in the group that received the placebo, 85 women developed the disease. Researchers came to the conclusion that, in postmenopausal women at high risk, anastrozole reduces the risk of developing breast cancer by one-half. Indeed, the results showed that for the anastrozole-treated women, the risk of developing breast cancer was reduced by 53%.


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