By distinguishing between people with ductal carcinoma in situ (DCIS) who will develop invasive breast cancer and those who won’t, the Cancer Grand Challenges PRECISION team could spare thousands of women around the world unnecessary treatment, transforming their quality of life.
We (virtually) sat down with PRECISION’s principal investigator, Jelle Wesseling, to discuss his motivations, the team’s aims – and the importance of looking beyond our own backyards.
What’s your scientific background?
I’m a consultant breast pathologist with a background in chemistry.
Where are you based?
For the past 15 years I’ve worked, or almost lived, at the Netherlands Cancer Institute in Amsterdam. It’s a wonderful mix of a high-level cancer hospital and a research institute, from fundamental through to applied clinical research. It’s a very inspiring place to work.
Could you tell us a bit more about your research?
When I started training as a pathologist, I realised that my looking at slides under the microscope is the reason someone might have their whole breast amputated – something that has a major impact on quality of life. Only around 1 in 4 people with DCIS will develop invasive breast cancer, so in many cases, the benefit of that surgery and wider treatment is doubtful.
The aim of the PRECISION team is to distinguish between harmless and hazardous DCIS, to help inform patient management – should they undergo treatment, or have active surveillance, or go back to population-based screening? It’s that improvement of quality of life that has always been my primary drive.
What’s the most exciting thing about working with the PRECISION team?
We had a lot of publicity in the Netherlands and a major spin-off effect of that is how it’s changing the perception of DCIS in society. People with DCIS come to me on a weekly basis and what I’ve seen over the past 5 years is an increase in awareness that their DCIS might not be cancer, and people starting to choose for themselves whether they want surgery or not.
It’s a special spin-off effect that I found quite surprising, and we’re very proud to bring our message to society.
What does global multidisciplinary collaboration mean to you?
As doctors, we all train to do ‘something’. Taking a step back in medicine and choosing not to treat someone is really hard, and so DCIS is almost always treated – you need really strong evidence to take a step back safely. And you need the global collaboration of different disciplines to drive that evidence base.
As scientists, we often work in our own backyard, so to speak. But we have to think about our own limitations – I could write methodology or molecular biology projects forever, but would it really change the field? We need to go beyond our own backyard, out of our comfort zone, to think about the broader landscape if we’re really going to turn things upside down and change things for patients in the clinic.
But also – it’s real fun. Working across disciplines and across nations brings such different perspectives to a problem, which is energising and inspiring.
What’s been the highlight of your past year?
It was really special that we discovered that women with larger fat cells surrounding DCIS had a higher risk of developing invasive breast cancer, in particular if the DCIS contained high levels of a protein called COX-2. This risk was low for women with small fat cells and low levels of COX-2.
What are you most looking forward to this year?
I very much look forward to integrating all the meaningful data that we have generated within the Cancer Grand Challenges PRECISION team, to ultimately answer the question posed at the start of our challenge: ‘When is cancer not really cancer?’.
This could ultimately save tens of thousands of women the burden of pointless treatment.