Table 8 Gap analysis recommendations and future directions
From: Evaluation of the current knowledge limitations in breast cancer research: a gap analysis
| Generic needs | Improved preclinical models. |
| Access to appropriate and annotated clinical material. | |
| Cross-disciplinary working. | |
| 1. Genetics of breast cancer | Encourage development of research techniques to allow integrated analysis of sequence-level, epigenetic and large-scale somatic changes. |
| Engage in national initiatives for activities such as high-throughput re-sequencing and UK controls. | |
| Encourage research involving intermediate phenotypes. | |
| 2. Initiation of breast cancer | Develop three-dimensional cell culture models, containing multiple cell types, which reflect the tissue architecture of the normal and diseased breast. |
| Generate better animal models, particularly for ER-positive tumours, in which gene expression can be manipulated in all cell types of the mammary gland and will not be altered by transdifferentiation or dedifferentiation. | |
| Gain a greater understanding of the genetic changes that occur within atypias and DCIS. | |
| 3. Progression of breast cancer | Improve preclinical models, research reagents and technologies (including imaging). |
| Enhance access to appropriate clinical material, including sequential samples obtained during treatments extending to new agents. | |
| Consider genetic signature/specific genetic lesions when exploring progression biology and designing clinical trials. | |
| 4. Therapies and targets in breast cancer | Build resources through the high-quality, uniform, multicentre collection of clinical material from breast cancer patients before and during treatment (including neoadjuvant studies), including samples of primary tumours as well as metastatic deposits. |
| Develop methods for easy, reproducible monitoring of response to and development of resistance to therapy, as well as early disease progression. | |
| Increase research efforts into the role of the tumour microenvironment and the immune system in the development and treatment of breast cancer. | |
| 5. Disease markers in breast cancer | Design innovative trials and translational studies to develop and evaluate predictive and prognostic markers. |
| Develop close multidisciplinary collaboration with high-quality histopathology and rigorous scientific assessments to validate new markers important for patient outcome. | |
| Identify robust markers of resistance or sensitivity to therapy that can be applied across the spectrum of breast disease from screen-detected to metastatic breast cancer. | |
| 6. Prevention of breast cancer | 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. | |
| 7. Psychosocial aspects of breast cancer | Develop and rigorously evaluate appropriate psychosocial interventions. |
| Encourage cross-speciality collaboration to incorporate psychosocial issues and psychological theory (for example, psychological theories in relation to behaviour change are relevant to those researching preventative lifestyles including diet and exercise). | |
| Ensure research gives greater attention to all stages of breast cancer and that the needs of older women and those from a range of ethnic groups are included. |