Optimal treatment of women with pre-invasive breast cancer

Background

Breast cancer is the commonest cancer in women in the UK. Before developing invasive breast cancer, some women have a pre-invasive cancer called ductal carcinoma in situ (or ‘DCIS’). DCIS can be detected on screening and it now accounts for one in five of all screen-detected breast cancers.

DCIS is treated with breast surgery. Women may then receive further treatment such as radiotherapy and, sometimes, endocrine therapy. However, there is substantial variation between clinicians in the extent to which they use these further treatments, both in the UK and worldwide.

In order to decide which post-operative treatments are most appropriate for each individual patient, the patient and their doctor both need information on the absolute benefits and the absolute risks of both radiotherapy and endocrine treatment. Multiple tools have been developed to help inform decisions on which women would most benefit from these further treatments. However, many of these tools are historic, developed on single centre cohorts, and poorly validated. As a result, they are not widely established.

The proposed project will:

• Identify the available decision tools available for informing treatment decisions in women with DCIS.
• Use population-based data collected, and made available by NHSE to our group, on all 80,000 women in England diagnosed with DCIS during 1990 to 2018, and followed to 2022, to evaluate the performance of these decision tools for women diagnosed in the clinic today.
• Explore whether existing tools can be improved, using information from randomised trials and routinely collected data sources.

The intention is to provide patients and clinicians with reliable up-to-date information on the risks and benefits of radiotherapy and endocrine therapy in a way that is easy to understand, so that it can be used in the clinic to help inform treatment decisions on an individual patient-by-patient basis.

research experience, research methods and skills training

The student will gain experience and skills in epidemiological research and analysis of large-scale prospective data. They will be supported to publish peer-reviewed papers emerging from their DPhil. 

FIELD WORK, SECONDMENTS, INDUSTRY PLACEMENTS AND TRAINING

The project will be based within the Benefits and Risks of Cancer Treatments group in the Richard Doll Building. In-house training in statistical and epidemiological methods, programming, and scientific writing will be provided.

PROSPECTIVE STUDENT

The candidate will have a good first degree in a subject with a strong mathematical content together with proficiency in a programming language such as R or Stata.  Additional experience or an MSc in statistics, epidemiology, or related subject would be an advantage.