PM.20.022 – Towards better prevention of breast and colorectal cancer

Route: Personalised medicine: the individual at the centre

Cluster question: 081 How will our knowledge of genetics play a role in analysing, screening for, and treating diseases?

In the year 2000, the completion of the human genome sequence was heralded as ‘the end of the beginning’, implying that the era of personalized medicine had begun. For disease prevention, however, the use of genomic information is mostly confined to a rare group of individuals carrying high-risk disease alleles. Our initiative focuses on our national population screening programs for breast and colorectal cancer. Participation is still based on age only, even though the potential for risk-stratified screening has massively improved the past decade. In principle, risk-stratified entry should produce a better balance of benefits, harms and costs for these screening programs, but quantitative estimates as well as the precise nature of this benefit are currently lacking. Our study can provide this information in 5-7 years, as well as develop an implementation plan for personalized screening of breast and colorectal cancer, both of which are in the top-3 of cancer-related deaths. We will generate a large population-based cohort of individuals free of cancer at study-entry and of ages 49 and 54, to maximize capitalization on the follow-up data coming from both population-screening programs (mammograms, FIT- and colonoscopy results) and the national cancer registry. A younger cohort, age 40, will teach us about the cancers now missed by population-screening. We will collect risk factor data by questionnaire and establish a genetic risk profile by DNA analysis, which can be combined to generate an individual 5-year risk estimate to develop breast or colorectal cancer. Health technology assessment will address the effects of various screening-entry criteria on health benefit for both cancers, and model this for other diseases as well. An evaluation of the ethical, legal and societal aspects will be addressed together with stakeholders from population screening programs, including questions regarding the return of results within the research setting.
Persons involved: Netherlands Cancer Institute (NKI): Prof. dr. M. van Leerdam, Prof. dr. M.K. Schmidt, Prof. dr. G. Meijer, Dr. S. Rebers, Prof. dr. J. Wesselig – Erasmus Medical Center: dr. I. Lansdorp-Vogelaar; prof. Dr. A.G. Uitterlinden – Amsterdam UMC: prof. dr. M. Cornel, dr. V. CoupĂ© – Rijksinstituut voor Volksgezondheid en Milieu: Dr. P. Hugen; National and international collaborative networks of organizations: HEBON (HEreditary Breast and Ovarian cancer in the Netherlands); BCAC (Breast Cancer Association Consortium); CIMBA (Consortium of Investigators of Modifiers of BRCA1/2); EU Horizon 2020 projects BRIDGES and B-CAST (on breast cancer) and CTMM DeCoDe, KWF/SU2C MEDOCC (on colon cancer). – We have initiated discussion with Prof. dr. C. van Gils (UMCU) and Prof. dr. M. Broeders (Radboud UMC) who have submitted an initiative on risk-stratification using mammogram images from breast cancer screening.

Keywords

Breast cancer, colon cancer, individual autonomy, personalized prevention, population screening, Risk stratification

Other organisations

Amsterdam UMC, BCAC (Breast Cancer Association Consortium), CIMBA (Consortium of Investigators of Modifiers of BRCA1, Erasmus Medical Center (EMC), EU Horizon 2020 projects BRIDGES and B-CAST (on breast cancer) and CTMM DeCoDe, KWF, National and international collaborative networks of organizations: HEBON (HEreditary Breast and Ovarian cancer in the Netherlands), Rijksinstituut voor Volksgezondheid en Milieu (RIVM), SU2C MEDOCC (on colon cancer). - We have initiated discussion with UMCU and Radboud UMC who have submitted an initiative on risk-stratification using mammogram images from breast cancer screening., The Netherlands Cancer Institute (NKI)

Submitter

Organisation Leiden University Medical Center (LUMC)
Name Prof. dr. P. Devilee
E-mail p.devilee@lumc.nl
Website https://www.lumc.nl/org/humane-genetica/medewerkers/peter-devilee