Table 6 Summary of the gap analysis for the prevention of breast cancer

What do we know?

Endocrine chemoprevention for oestrogen-responsive tumours works.

Key risk factors include mammographic density, post-menopausal weight gain, high-calorie, high-fat diets and lack of exercise.

Breast screening is effective. MRI screening is more sensitive than mammography for high-risk women

Epidemiological data suggest weight control, low-fat diet and exercise after diagnosis improves outcome of early breast cancer patients.

What are the gaps?

The long-term effects of chemoprevention of ER positive cancers are unknown.

Prevention of ER-negative cancers remains a challenge.

There is a need to understand the target cell for breast cancer prevention.

Need to improve current risk prediction models by including modifiable risk factors.

The health beliefs of high-risk and population risk women require exploration.

The effects of breast screening out with currently targeted groups is not known.

To define deliverable diet and exercise interventions for the primary and secondary prevention of breast cancer.

To elucidate the mechanism for breast cancer prevention with energy restriction.

Problems

Accrual and retention of women in prevention trials.

Better models to research new chemoprevention agents.

Breast screening lags behind advances in imaging technology.

Poor uptake to diet and exercise trials after diagnosis.

Translational implications

Better identification of high-risk women would allow chemoprevention to be targeted more effectively.

Defining optimum screening methods will ensure more effective use of limited NHS resources.

The development of energy-restriction mimetics for breast cancer prevention.

Optimal diet and exercise interventions could improve quality of life and outcome for women with breast cancer.

Recommendations

Improve breast cancer risk prediction models.

Encourage transdisciplinary input to prevention trials (for example, geneticists, epidemiologists, nutritionists, psychologists and clinicians) to study the psychosocial, compliance and genetic aspects of prevention.

Establish the potential benefits of diet and exercise post-diagnosis on outcome and quality of life for breast cancer patients.