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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.