BCAC advocates Libby Burgess and Fay Sowerby enjoyed the recent Breast InSIGhts conference, an educational and networking event for breast cancer clinicians held in Auckland. The conference is held every two years, aiming to update local clinicians in international best practice treatment and care so this can be offered to NZ patients. There were indeed many insights shared by the local and international expert speakers. We describe a few highlights below.
Pharmac’s new approach
The conference was addressed by Pharmac’s new CEO Natalie McMurtry who stated that she wants Pharmac to be part of the team treating breast cancer. She shared her personal knowledge of breast cancer through the diagnosis and treatment journey of a close friend, acknowledging the need for more targeted, less toxic modern medicines. She noted that of 256 medicine applications going through Pharmac’s assessment pathways, 21 are for breast cancer medicines and eight of these are already on Pharmac’s funding wish list.
Pharmac’s Director, Pharmaceuticals, Adrienne Martin acknowledged the engagement and valuable input of the Consumer and Patient Working Group into Pharmac’s organisational Reset. She confirmed Pharmac’s aim of improving and modernising its assessment processes to deliver timely access to the medicines people need, working in partnership with consumers, clinicians and suppliers.
Personalised care and prophylaxis to maximise benefits of new medicines
Washington Professor of Medicine, Sara Hurvitz outlined the 13 new medicines that have been approved for breast cancer since 2020. She noted that to gain the maximum benefits, real world care needs to be individualised when delivered to broader populations that are more diverse than those selected for clinical trial participation. Clinicians can avoid hospitalisation of their patients if they prescribe prophylactic medicines such as anti-diarrhoea medicines and granulocyte-colony stimulating factor medicines such as filgrastim to stimulate white blood cell production and avoid neutropenia. Prophylaxis that avoids severe side effects can also mean less treatment dose reduction and greater efficacy. Monitoring and rapidly responding to side effects is very important in maximising treatment adherence, especially with oral medicines. Supportive care offered by multidisciplinary teams leads to better treatment and outcomes for patients.
Optimising treatment of DCIS
Prof. Habib Rahbar, also from Washington, noted the importance of distinguishing between fast growing dangerous DCIS (ductal carcinoma in situ) and the more indolent slow growing type. While clinicians aim to avoid unnecessary surgery and radiation treatment they must ensure effective treatment of more aggressive disease. Trials are under way to evaluate biomarkers that can identify whose disease will become invasive. MRI is an excellent tool for visualising the extent and grade of DCIS that has the potential to guide treatment optimisation.
Long-term benefits of shutting down oestrogen and treatment adherence
Prof. Prue Francis of Melbourne discussed 15-year outcomes from the SOFT and TEXT clinical trials that she led. The trials showed the addition of ovarian function suppression (OFS, e.g. goserelin (Zoladex®)) to endocrine therapy in premenopausal women with hormone receptor positive early breast cancer provides durable long-term benefits. The disease was less likely to return in those who had received OFS with tamoxifen or exemestane (E), with the least recurrence in the E + OFS group. There was a significant survival advantage of E + OFS in higher risk groups such as those under the age of 35 or with larger tumours (>2cm) or grade 3 tumours.
Treatment adherence is a problem with these treatments because of side effects such as hot flushes and other menopausal symptoms including vaginal dryness and reduced sexual interest and enjoyment. Youngest patients get the greatest benefit from treatment and ten years of endocrine therapy is better than five so it’s vital that clinical teams provide good support and information on symptom management. A new type of medicine (elinzanetant, Lynkuet®) that blocks receptors causing vasomotor symptoms was shown in the Oasis trial to be effective in controlling hot flushes in many women receiving endocrine therapy. This medicine and a similar one, fezolinetant (Veoza®) is now approved in Australia, Canada, the UK, the US, and the EU but not yet registered by Medsafe or funded by Pharmac in NZ. Oncologists report they are prescribing fezolinetant “off label” under Section 29 of the Medicines Act and that it is life-changing for some patients. We advise shopping around pharmacies that import medicines (your oncology clinic may do this for you) as we’ve heard that prices vary from $230 to $675 per month. You can read more about sexual health after breast cancer here.
The benefits of exercise
Assoc. Prof. Yvonne Zissiadis from Western Australia reported that there is increasingly mature data showing the robust positive effects of exercise of important cancer and other health outcomes. Structured exercise programmes have demonstrated reduced recurrence of disease in patients with colorectal cancer. There are other physical and mental benefits of exercise such as enhanced strength, improved cardiovascular and metabolic function, better sleep, reduced fatigue and anxiety and better quality of life. Treatments may be better tolerated and immune function can be enhanced.
Click here to find some exercise videos designed especially for kiwi women after breast cancer surgery.
NZ’s world-leading breast cancer data
Sue Kleinsman, manager of the Breast Cancer Foundation’s (BCF) National Register, Te Rēhita Mate Ūtaetae, updated us on this valuable resource. Data on pre-invasive and invasive breast cancer patients in New Zealand has been collected for over 25 years and 60,000 patients are now registered. Data fields include risk factors, diagnosis, stage, grade and sub-type, histology, surgery, medicines, radiation therapy and follow-up care. Every year around 4,000 new patients are added from 97% of those diagnosed in NZ, with regional coverage almost complete. Fewer than1% of patients choose to opt out. Individual patient data is kept strictly confidential. The data in the Register is used to understand breast cancer in the NZ population, to improve diagnosis, treatment and patient outcomes. We truly appreciate BCF’s long-term investment in the Register and the knowledge it generates.
Clever pathology
Prof. Sandra O’Toole from Sydney described tumours as complex cellular ecosystems. She noted the importance of ‘omic’ technologies, i.e. high throughput biological methods to analyse molecules such as DNA, RNA, proteins and metabolites to understand the structure, function and dynamics of biological systems. Omics offers powerful tools to enable research and personalised medicine. While omic techniques have huge potential to provide insights into tumour biology and treatment response they are currently very expensive. Use of AI may allow omics to become more affordable, but AI needs to be carefully implemented to ensure safety, accuracy and absence of bias.
Chemoprevention of breast cancer in high-risk women
Assoc. Prof Anna Weiss from New York spoke of the effectiveness of “chemoprevention”, i.e. anti-oestrogen medicines, in lowering the incidence of breast cancer in high-risk women, such as those with strong family history or pre-cancerous breast cells. Patients avoid this strategy because of reported side effects and historically poor management of these. Using a lower dose of tamoxifen remains effective while reducing symptoms and new drugs may also help. Adjuncts such as yoga, meditation and acupuncture should be offered. It’s also vital to address sexual wellness concerns.
Personalised risk-based follow-up
Prof. Wendy DeMartini from California stated that breast cancer follow-up is entering the age of precision surveillance and that imaging schedules should depend on an individual’s risk instead of being uniform for all. Higher risk patients would benefit from intensified imaging and molecular monitoring while those at low risk of recurrence could have less frequent imaging with standard clinical surveillance. Advanced imaging is rapidly evolving, enabling earlier detection and allowing improved diagnostic accuracy. Liquid biopsy, analysis of bodily fluids such as blood or urine, uses ctDNA (DNA from tumours) or CTCs (circulating tumour cells) to allow for real time monitoring of cancers. This will increasingly personalise surveillance, enable early detection of relapse and guide imaging and therapies. AI and radiomics (advanced data-driven image analysis) will support clinical decision making.
Empowering patients with advanced breast cancer to live well and long
Prof. Sara Hurvitz spoke about the need to balance survival and quality of life in advanced (metastatic) breast cancer (ABC). Survival duration has improved greatly with better treatments, with around 25% of those diagnosed in 2008 alive 10 years later, so ABC is a long journey. Those living with breast cancer want to have a normal life despite receiving toxic treatments. Psychological challenges come with uncertain prognosis, fear of progression, disruption of life roles and treatment toxicity. Some patients describe ABC as “living scan to scan”. Hope is a powerful tonic allowing better coping, improved treatment adherence and may improve outcomes. Clinicians, while communicating uncertainty, must never take hope away from their patients. Personal and family milestones are important. These may be career achievements, bucket list adventures, seeing children or grandchildren go to school, graduate, marry etc.
Those with ABC experience cumulative toxicities, psychological uncertainty, financial and functional impacts and frequent engagement with healthcare. Distinct survivorship models are needed that differ from early-stage survivors. Follow-up visits should address four domains: disease control, treatment toxicity, symptom burden and importantly, patient priorities and quality of life (QoL). The framework for visits should be “is the treatment helping more than it is harming?”.
A multi-country patient survey on QoL published by leading ABC oncologist Fatima Cardoso identified the most impactful treatment-related side effects. These were fatigue, insomnia, anxiety, back pain, diarrhoea, hot flushes, low sexual interest and loss of appetite. Many of these are not severe but low-grade chronic toxicities. Symptoms should be proactively discussed and managed. Shared decision making in the context of realistic expectations will empower patients. Doctors should be asking “How is treatment affecting your daily life?” What are you hoping treatment will achieve?” and “What trade-offs are acceptable to you?”.
“Palliative care” is a scary term for patients, but it is not end of life care. It is supportive oncology throughout the disease course and should be integrated into treatments and care within months of a diagnosis of ABC. Benefits are better communication and symptom management and better alignment of treatment goals between patient and oncologist.
8 April 2026
