Published Wed, 2010-09-29 14:07; updated 34 weeks ago.

A quick guide to what's on this page

Research into treating breast cancer

All treatments must be fully researched before they can be adopted as standard treatment for everyone. This is so that we can be sure they work better than the treatments we already use. And so we know that they are safe.

First of all, treatments are developed and tested in laboratories. Once we know they are likely to be safe, they are tried in clinical trials in people.

For breast cancer, researchers are looking into surgery, including new ways of checking lymph nodes and removing secondary cancers, radiotherapy, chemotherapy, hormone therapy, biological therapies, and better ways of picking up a cancer that has come back.

You can view and print the quick guides for all the pages in the Treating breast cancer section.

 

Why we need research

Research goes on all the time into how best to treat breast cancer. Usually doctors test new treatments in people with advanced breast cancer first. If a new treatment helps with advanced breast cancer, it may work for early stage breast cancer. So it is then tested in clinical trials to see if it lowers the risk of the cancer coming back.
 
Doctors would like to be able to identify who is most at risk of their breast cancer coming back. Then they can give treatment to those women and avoid giving treatment that may cause side effects to women who don't really need it. At the moment, we don't know for sure who is most at risk so research is looking into this.
 
Surgery
 
Surgeons in the UK and the rest of Europe are looking into keyhole surgery for breast cancer. Keyhole surgery has been used in Japan for many years to take away breast tumours in women with small breasts who need a mastectomy. In keyhole surgery, a small cut is made close to the breast and another cut close to the nipple. The surgeon passes a thin tube called an endoscope through the hole into the breast tissue. The tube has a small camera at the tip so the surgeon can see and remove the cancer cells.
 
Keyhole surgery gives less scarring than standard operations to remove the breast (mastectomy) or remove the breast lump (wide local excision). After mastectomy an inflatable breast implant (prosthesis) can be put in through the cut to replace the tissue that the surgeon removes. The implant is slowly inflated over a few weeks to give a normal breast shape. It is not yet clear whether this type of surgery is as good as standard breast surgery in getting rid of the cancer completely.
 
Doctors in the UK are starting clinical trials to compare keyhole surgery to standard surgery. This type of surgery needs specialist equipment and must be carried out by surgeons with specialist training. So it is only available at a few hospitals in the UK. The National Institute for Health and Clinical Excellence (NICE) have issued guidance that there is currently not enough evidence about the safety and effectiveness of keyhole surgery for breast cancer and say that these procedures should only be used as part of research.
 
Checking the lymph nodes
 

It is usual now to have a sentinel node biopsy at the same time as having your breast cancer removed. This means that the surgeon removes the lymph node most likely to contain cancer cells from the tumour. If cancer cells are found in the sentinel node, they may also have spread further in the body. You will need to have more treatment to the lymph nodes in your armpit. The Amaros trial is trying to find out whether radiotherapy to this area, or surgery to remove these lymph nodes, is the best way to stop the cancer coming back in this area, and how the side effects compare. The trial is now closed and we are waiting for the results. 

Some research is also looking into a new way of checking whether the cancer has spread into the lymph nodes under the arms. It is called endoscopic axillary lymph node retrieval. The surgeon needs to have specialist training in the technique. They make very small cuts in the skin of the armpit and insert tiny tubes and special instruments. Liposuction removes any excess fat in the area and the surgeon then removes some lymph nodes. NICE recommends that currently this procedure is only used in research trials.

Tests to decide on treatment after surgery

Usually doctors do tests to check the stage and grade of a cancer to decide who should have more treatment after surgery. The MINDACT trial is looking into whether genetic testing can help to decide who should have particular types of treatment after surgery for early breast cancer. These are called genomic tests.

If you are in this trial, you will have standard tests and genomic tests. If the tests suggest that you are at a high risk of the cancer coming back, you will have chemotherapy. If both tests suggest you are at low risk, you will not have chemotherapy. If one test suggests that you should have chemotherapy, but the other does not, you will be put at random into one of two groups, and you may or may not have chemotherapy. Different chemotherapy combinations are being used as part of the trial. Your cancer cells will also be tested to see in they are hormone receptor positive. If the cancer cells have hormone receptors, you will have hormone therapy.

 
Chemotherapy
 

There is an enormous amount of research going on into breast cancer chemotherapy. You can find detailed information about chemotherapy trials for breast cancer on our clinical trials database. Go to the advanced search and choose 'breast' from the dropdown list of cancer types, then choose chemotherapy from the type of treatment list. For details of closed trials, tick the box for trials that have finished recruiting.

This page includes information about 

New chemotherapy drugs and combinations

Doctors are continually trying to find new chemotherapy drugs to improve breast cancer treatment. They also try to find better ways of using current chemotherapy drugs such as giving them more often or in different doses. 

Some of the new drugs and combinations being used after breast surgery in trials include

Some people have chemotherapy before surgery to shrink their breast cancer so that they can then have smaller operations to remove the cancer. Doctors call this neoadjuvant therapy. Trials are comparing different chemotherapy combinations before surgery to see which work best.

Monitoring effects of treatment

Doctors are also looking at using new types of scans to monitor treatment effects during chemotherapy. They want to see if these scans are better at monitoring breast cancer than the scans we currently use. The scans include 

  • PET scans
  • Infrared scans that process temperature differences in the breast and create a colour coded picture
  • 3D ultrasound that takes a detailed ultrasound picture of the breast
  • Ultrasound elastography scans that highlight rigid areas of tissue in the breast, which indicates an area of cancer. 

Protecting the ovaries during treatment

Chemotherapy can damage the ovaries and cause an early menopause in premenopausal women. In the OPTION trial, doctors are giving a hormone therapy called goserelin to women having chemotherapy. Goserelin temporarily stops the ovaries working, and doctors hope this will allow the ovaries to work normally again once the chemotherapy has ended. It is not yet clear how well this may work in preventing early menopause. The trial has closed and we are waiting for the results. 

Using chemotherapy with biological therapy drugs

Some trials are looking at combining chemotherapy with  biological therapy drugs such as bevacizumab (Avastin) (a monoclonal antibody), everolimus (Afinitor), gene therapy, and sunitinib (Sutent). There is information about trials combining chemotherapy with biological therapy lower down this page.

Chemotherapy for triple negative cancers

Triple negative breast cancers don’t have receptors for oestrogen, progesterone or HER2. So hormone treatments and Herceptin do not work well for them. About 15 in 100 breast cancers (15%) are triple negative. The TNT trial is comparing docetaxel and carboplatin chemotherapy for women with triple negative breast cancer that has spread to another part of the body, to see which works best.

Chemotherapy side effects

Researchers are looking at ways of reducing the side effects of chemotherapy. 

People having chemotherapy are more likely to pick up an infection. This is due to a drop in white blood cells called neutrophils (pronounced new-tro-fills). The SPROG trial has looked at giving chemotherapy with a drug that stimulates white blood cell production called G-CSF to see if this lowers the number of infections people get during a course of chemo. This trial is no longer recruiting patients and we are waiting for the results.

Epirubicin is a chemotherapy drug often used to treat breast cancer, but it can cause damage to the heart. A small study, called BETTER-CARE has collected heart scans and blood tests from a number of women having epirubicin to see which of them are affected. Scientists hope they will be able to find a genetic test to identify which patients are more at risk of heart damage. This would mean that these women could be given lower doses than those with a small risk. The trial has closed and we are waiting for the results. 

Capecitabine is a form of the chemotherapy drug fluorouracil that you take as a tablet. It can be used to treat advanced breast cancer, either on its own or with docetaxel. One of the side effects of this is that the palms of your hands and the soles of your feet may become red, sore, numb or painful (palmar-plantar syndrome). Doctors often prescribe a tablet called pyridoxine (vitamin B6) to help control this. However, there isn't much evidence to show how well pyridoxine works. A trial called CAPP-IT has been trying to find out the best dose of pyridoxine for breast cancer patients taking capecitabine. This trial is no longer recruiting patients, and we are waiting for the results.

All these trials are on our clinical trials database.

 
Radiotherapy
 
Early stage breast cancer is usually treated with surgery, and then with radiotherapy to help stop the cancer coming back. The radiation destroys cancer cells that may have been left behind after your operation. If you have radiotherapy to treat your breast cancer you will usually have small daily doses, from Monday to Friday, for between 3 and 6 weeks. A trial called SUPREMO is looking at whether radiotherapy after mastectomy helps women who are  an intermediate risk of their cancer returning. It also wants to find out the effects of this treatment on quality of life.
 
Doctors are looking at several different ways of using radiotherapy to treat breast cancer. These include
 
  • Targit, Electron Intraoperative Radiotherapy (ELIOT) and brachytherapy
  • Intensity Modulated Radiotherapy
  • Radiotherapy after surgery for breast cancer for older women
  • Changing the doses of radiotherapy
  • Radiotherapy to stop HER2 positive breast cancer spreading to the brain
Targit, Electron Intraoperative Radiotherapy (ELIOT), brachytherapy and electronic brachytherapy
 
Going to the hospital every day during the week can be very tiring, especially if you live a long way away. Doctors are looking at simpler, quicker ways of giving radiotherapy to women with early stage breast cancer including targit, electron intraoperative radiotherapy and brachytherapy. These are all ways of giving radiation inside the breast tissue, instead of aiming it onto the breast from a machine outside the body. The big advantage is that treatment takes much less time than the usual 6 weeks. If successful, these methods could mean speedier treatment for many women with breast cancer and less pressure on radiotherapy equipment and staff. But we need more research before we will know the true benefit.
 
Targit is a way of giving radiotherapy to women during their breast cancer surgery. It stands for TARGeted Intraoperative radioTherapy. Doctors put an applicator inside the breast after the surgeon has removed the breast cancer. Once the applicator is in exactly the right place, the doctors put a radioactive source inside it for 10 to 30 minutes. This gives radiotherapy directly to the tissue around the cancer. The rest of the operation then goes ahead as normal. There don't seem to be any serious side effects. Your wound may take a little longer to heal after surgery with this type of treatment.
 
ELIOT stands for electron intraoperative radiotherapy and involves having a single high dose of radiation at the same time as surgery to remove the cancer. After taking out the cancer, the doctor uses a small machine to make and deliver radiotherapy beams directly to the area where the cancer was. The machine gives the radiotherapy to your breast for about 25 minutes. The doctor can shape the radiation beam accurately to fit the area that contained the tumour. As there is less normal tissue in the way of the radiotherapy beam, you may have fewer or less severe side effects. It is early days for this treatment and there is not very much research into it in the UK at the moment.
 
Brachytherapy means giving radiotherapy from the inside of the body (internal radiotherapy). It is not often used to treat breast cancer. But now doctors are testing a new type of brachytherapy after lumpectomy surgery as part of the FORUM trial. They use a new device called MammoSite RTS. After you have had surgery to remove your breast tumour, MammoSite can give radiation doses directly into the tissue in this area. First, your doctor puts a tube like a deflated balloon into the breast tissue. You may have this done at the time of your surgery or up to 10 days later. The doctor fills the balloon with salt water (saline) and then threads a tiny wire containing the radiation dose into the balloon. The wire stays in place for a few minutes to give the right amount of radiation and then the doctor removes it. You have this treatment twice a day for about 5 days. The doctor then takes the balloon out. You can find details of the FORUM trial on Cancer Research UK’s clinical trials database.
 
Electronic brachytherapy (eBx) is used in some hospitals. Low energy x-rays are given directly into the operation area after removing the breast tumour. The low energy rays do not travel so far into the body tissue. Doctors hope that this will improve the appearance of the breast after surgery compared to standard brachytherapy techniques.
 
Intensity modulated radiotherapy (IMRT)
 
Radiotherapy is a standard treatment for breast cancer. But, for some women, it can be difficult to give an even dose of radiotherapy throughout the breast. Women's breasts vary a lot in shape and size. An uneven delivery of radiotherapy to the breast can cause long term side effects, such as scar tissue. This can make the breast shrink. Doctors are trying to find ways to prevent this. They have already developed 'conformal radiotherapy' that shapes the radiation beams to exactly fit the area where the breast cancer was.
 
Now researchers are testing intensity modulated radiotherapy (IMRT), which changes the radiotherapy dose depending on the thickness of the breast tissue. So the whole area treated gets the same dose. A study looking at whether IMRT improves the appearance of the breast tissue has now closed, and we are waiting for the results.
 
Radiotherapy after surgery for breast cancer in older women
 
All treatments have some side effects and it is important that patients do not have treatments they don't need. There is some evidence that women over 65 with low grade breast cancer may not need radiotherapy after surgery to remove their cancer. Low grade cancer is generally less likely to come back than higher grade cancers.
 
The PRIME 2 trial aims to find out whether radiotherapy after surgery reduces the chance of recurrence in women over 65 who are at low risk of their cancer coming back. It also aims to find out whether radiotherapy affects their quality of life. This trial has closed and we are waiting for the results.
 
Changing the doses of radiotherapy
 
Radiotherapy causes unwanted side effects. Doctors want to reduce these side effects as much as possible without affecting how well the treatment works. The IMPORT LOW trial is looking at changing the amount of radiotherapy given to women with low risk early stage breast cancer after breast conserving surgery. Some women in this trial had the standard dose of radiotherapy to the area where the cancer was, but others had a lower dose, or none at all, to the rest of the breast. The trial has now closed and we are waiting for the results.
 

IMPORT HIGH is looking at radiotherapy after breast conserving surgery in women with early stage breast cancer, who have an average or above average risk of the cancer coming back. If you join this trial, you may have a higher than standard dose of radiotherapy to the area where the cancer was, but a lower than standard dose to the area of the breast furthest away from the cancer. We have information about the IMPORT trials in our breast cancer question and answer section.

Radiotherapy to stop HER2 positive breast cancer spreading to the brain

If breast cancer spreads, it can sometimes spread to the brain. The HER-PCI trial is looking at giving radiotherapy to the brain, to see how well it stops this happening. It is for women who are due to have Herceptin (trastuzumab) for breast cancer that is locally advanced or has spread to another part of the body. Doctors want to find out how good this treatment is at stopping this type of breast cancer from spreading to the brain, and learn more about the side effects. This trial is now closed and we are waiting for the results. 

You can find details of radiotherapy for breast cancer trials on our clinical trials database. Go to the advanced search and choose 'breast' from the dropdown menu of cancer types and 'radiotherapy' from the list of treatments.

 
Hormone therapy
 

Many women with breast cancer have hormone therapy. Tamoxifen was the first hormone therapy for breast cancer. It can greatly reduce the chance of the breast cancer coming back for some women. Women used to take tamoxifen for only 2 years after they were first treated. Now we know that it is better to take it for 5 years. Doctors are now researching whether it is even better to take it for up to 10 years after surgery for early breast cancer. We need to test this because taking the drug for longer won’t necessarily lower the risk of breast cancer coming back and could increase the side effects. Doctors are also concerned that taking the drug for longer could increase the risk of side effects.

Research has shown that aromatase inhibitors are effective in preventing cancer coming back for some women. These drugs are usually only used for women who have gone through the menopause. Trials have shown that for women with early breast cancer, who have had their menopause, switching to an aromatase inhibitor after 2 or 3 years of tamoxifen reduces the risk of the cancer coming back and gives fewer side effects than tamoxifen. Aromatase inhibitors include exemestane (Aromasin), anastrozole (Arimidex) and letrozole (Femara).

Research is testing aromatase inhibitors for women who have not yet had their menopause. Some trials are comparing aromatase inhibitors to other treatments, including stopping the ovaries from working (ovarian ablation), celecoxib and triptorelin. Other trials are looking at giving aromatase inhibitors before surgery to see if they can shrink cancers before surgery and reduce the area that needs to be operated on.

The IBIS 2 (DCIS) trial is comparing hormone therapies for early, in situ breast cancers (DCIS). Women in this trial take either tamoxifen or anastrozole after surgery to remove DCIS. The aim of the trial is to see if this treatment lowers the risk of the DCIS coming back.

Some trials are looking at newer hormone therapies such as Trilostane, fulvestrant (Faslodex) and abiraterone. Abiraterone stops the body producing oestrogen and androgens (male sex hormones). It seems that some breast cancer cells have androgen receptors. This is called AR positive breast cancer. Doctors want to see if abiraterone can help women with this type of breast cancer when it has stopped responding to other treatments.

Some trials are combining hormone therapy with biological therapies for advanced breast cancer.

You can find out more about hormone therapy trials for breast cancer on our clinical trials database. Go to the advanced search and choose 'breast' from the dropdown menu of cancer types and 'hormone therapy' from the list of treatment types. If you want to see all the trials, tick the boxes for closed trials and trial results.

 
Biological therapies
 

Biological therapies are treatments with substances that are made naturally by the body or that affect normal body processes. Many types of biological therapy are being tested for breast cancer. Some therapies are tested alongside standard treatments of chemotherapy, hormone therapy or radiotherapy. 

We describe some of the types of trial below but you can find detailed information about biological therapy trials for breast cancer on our clinical trials database. Go to the advanced search and choose 'breast' from the dropdown menu of cancer types and 'biological therapy' from the list of treatment types. If you want to see all the trials, tick the boxes for closed trials and trial results.

  • Biological therapy before breast surgery
  • Biological therapy to prevent breast cancer coming back
  • Biological therapy for breast cancer that has spread

Biological therapy before breast surgery

Some trials are looking at using biological therapies called monoclonal antibodies, such as Herceptin (trastuzumab) or cancer growth blockers such as lapatinib (Tyverb) to see what effect they have on a breast cancer before surgery. The ARTemis trial is looking at giving the monoclonal antibody bevacizumab (Avastin) with chemotherapy before surgery.

Biological therapy to prevent breast cancer coming back

Some trials are using biological therapies after treatment for early breast cancer to see if they can lower the chance of the cancer coming back. Some of the biological therapy drugs being used in this way include trastuzumab (Herceptin) and lapatinib (Tyverb). Some trials are comparing different ways of giving the drugs or giving them for different lengths of time to see which works best. Other trials are combining them with chemotherapy or hormone therapy. There is information about Herceptin trials for early stage breast cancer in the breast cancer question and answer section.

Some trials are looking at whether particular types of biological therapy, such as denosumab (Prolia), can reduce the chance of breast cancer spreading to the bones.

Biological therapy for breast cancer that has spread

Many trials are looking at using biological therapies to control breast cancer that has spread beyond the breast or to other parts of the body. The drugs being used in this way include Herceptin (trastuzumab), bevacizumab (Avastin), lapatinib (Tyverb), sunitinib (Sutent), denosumab (Prolia), everolimus (Afinitor), olaparib (AZD2281), iniparib (BSI-201), panobinostat (LBH589), temsirolimus, neratinib, pertuzumab, ATN-224, vaccine therapy and TKI258.

 
Bisphosphonate drugs
 

Bone pain and fractures can be a problem in advanced breast cancer that has spread to the bones. The growth of the cancer starts to destroy bone tissue and weakens the bone in that area. Bisphosphonate drugs can help to

  • Control bone pain so that you need fewer painkillers
  • Slow down the damage caused to bone from bone secondaries, preventing fractures and pressure on the spine

Trials are looking into the most effective bisphosphonates to use in people with advanced breast cancer, and when to use them. Some trials are comparing how well bisphosphonates work compared to other types of treatment, such as radiotherapy, hormone therapy or chemotherapy. Some trials are looking at drugs given by tablet or as drips. Other trials are giving bisphosphonates alongside chemotherapy or hormone therapy. Bisphosphonates being tested in advanced breast cancer trials include zoledronic acid (Zometa) and ibandronate.

Researchers are also looking into using bisphosphonates to treat breast cancer at an earlier stage. Giving bisphosphonates to women who have stage 2 or 3 breast cancer may help prevent the cancer from coming back after surgery or radiotherapy. The D-CARE trial is trying to find out if a bisphosphonate called denosumab can stop or delay breast cancer spreading to the bones. 

Researchers also think that bisphosphonates may help to strengthen bones in women taking  aromatase inhibitor drugs as part of their breast cancer treatment. 

You can find detailed information about trials of bisphosphonates for breast cancer on our clinical trials database. Go to the advanced search and choose 'breast' from the dropdown menu of cancer types and 'bisphosphonates' from the list of treatment types. If you want to see all the trials, tick the boxes for closed trials and trial results.

 

Treating inherited breast cancer

A small proportion of women (3 to 5%) have breast cancer because they have inherited a faulty gene. It is not known if treatment works in the same way for these women as for women who do not have an inherited faulty gene (sporadic breast cancer). So a trial has been comparing the treatment effects and outcomes in 2 groups of women with breast cancer. One group has an inherited faulty gene (hereditary breast cancer). Women in the other group do not have the faulty gene. The trial is called the POSH trial and aims to find out whether women younger than 41 with hereditary breast cancer need to have different treatment from other women with breast cancer. This trial is no longer recruiting patients and we are waiting for the results.

There is a trial testing a drug called AG-014699 in women with breast cancer who have a faulty BRCA1 or BRCA2 gene. You may be able to enter this trial if you have locally advanced or advanced breast cancer. AG-014699 is a PARP-1 inhibitor which means that it stops the PARP-1 enzyme from repairing damaged cancer cells.

 
Removing secondary cancers
 

Experimental work is looking into removing secondary cancers. This is only suitable for a small number of people. Surgeons most often remove secondary cancers from the liver, although they can sometimes remove them from the lungs. Your doctor can only do this type of surgery if there are just one or two areas of secondary cancer in your liver or lungs. Before they decide to go ahead, they will also consider your general health, how advanced your cancer was when you were diagnosed, and how quickly your cancer came back.

A few different techniques are being tried to remove secondary cancers

Treating or removing secondary cancer may slow it down or keep it under control for a time. 

Cryotherapy means using a freezing probe to kill and remove tissue. Radiofrequency ablation uses a heated probe. The main difference between these techniques and conventional surgery is that your doctor puts the probe through the skin. So you do not need to have a general anaesthetic. Your doctor will give you a sedative to make you drowsy. In the experimental work that has been done, some patients have had treatment several times. It is important to talk things through with your doctor before going ahead. These are not easy treatments to have. You will feel sore and bruised for some days afterwards.

Surgeons have developed a new type of surgery for people with liver tumours in parts of the liver that are usually impossible to treat with surgery – for example, when the tumour is very close to major veins that connect to the liver. This type of surgery is very new and experimental and is used when the patient would die if they did not have the surgery. There is a risk of dying from the surgical operation. The operation involves removing the liver from the body, cutting away the diseased tissue, and then putting back the healthy liver tissue. It is called ex-vivo hepatic resection and reimplantation for liver cancer.

The National Institute for Health and Clinical Excellence (NICE) has issued guidance to the NHS in England, Wales, Scotland and Northern Ireland about this surgery. They say that there is limited evidence for the safety of this type of operation and it is not clear how well it works but it may be helpful for some people with secondary liver cancer. People having the procedure must receive full information about the possible risks and benefits.

 
Celecoxib after early breast cancer
 
Doctors think that a drug called celecoxib may help to stop some breast cancers coming back after treatment. Celecoxib is a type of drug called a Cox 2 inhibitor. These drugs block a protein called Cox 2 that may help cancers to grow. The REACT trial is looking at whether celecoxib can reduce the chance of an early breast cancer coming back.
 
Picking up on cancer that has come back
 

A study is looking at symptoms which could be caused by cancer coming back after treatment. After treatment for cancer of the breast, lung, prostate or bowel, you have follow up appointments with your specialist doctor. But after a few years, if you stay well, these appointments may stop. You are then asked to see your GP if you have any new symptoms, or are worried about anything.

Researchers looked back at the medical notes of people who went to their GP with symptoms some time after cancer treatment. They looked at people whose cancer had come back as well as people whose symptoms were caused by something else. The trial aims to find common symptoms of cancer recurrence to help doctors spot the signs that cancer may have come back. The trial has now closed. You can find details on our clinical trials database. Choose 'breast' from the dropdown menu of cancer types to find breast cancer trials.

Cancer cells in the bloodstream

The DETECT study is a pilot study looking at cancer cells in the bloodstreams of women with breast cancer that has spread to other parts of the body. Small numbers of cancer cells can be found in the bloodstream. They are called circulating tumour cells (CTCs). Doctors want to know more about these cells. They hope this will help them to understand more about how breast cancer spreads, so that they can develop new treatments. You can find out about this trial on our clinical trials database – type detect into the text box.

Research into breast cancer in men
 
Breast cancer in men is very rare and so there are fewer clinical trials than for more common types of cancer. Much of the information about how to treat breast cancer in men has been learnt from research into breast cancer in women. To try to resolve this a group of experts from all over the world have joined together to develop an International Male Breast Cancer Program. They aim to collect information about men who were diagnosed with breast cancer over the past 20 years and to collect information about those diagnosed now. They will look at the different risk factors, types of tumours, the markers on the tumour, treatment, and how well treatments worked. They aim to gather enough information to do clinical trials specifically for men with breast cancer.

Taken from CancerHelp UK, the patient information website of Cancer Research UK.
 
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