THERE are those who move among us who know how it feels to wear clothes which are made to measure.
They know that the jacket will always fit exactly across the shoulders, that sleeve lengths are spot on, that there are no troubling bulges when buttons are fastened. They stride around secure in the knowledge that their trousers sit on the waist with no need of belt or braces.
Imagine how good that must feel. Imagine what it would be like if medicine was the same, in particular the kind of treatments given to breast cancer patients – to have drugs that are tailor-made to fit their specific circumstances.
That, according to Professor Mike Dixon, one of the world’s most eminent breast surgeons, is what he and his team of researchers at the Western General – funded by charity Breakthrough Breast Cancer – are trying to do. Ultimately they want to be the Savile Row of breast cancer medicines – without the price tag.
“Personalised treatment that’s what we’re looking at, that’s what our research is all about,” says Dixon. “Our starting point is ‘how do we treat you and your cancer?’ At the moment we only have so many tools – surgery, chemotherapy, radiotherapy and hormone drug therapy – and you can only play them in so many different ways, so many different times in order to make advances.
“So what we’re trying to discover is which patients will get the most benefit from which drug. We are developing a test which will be able to tell us that from the first biopsy that’s taken, so the drug therapy can be much more tailored to the individual.”
For the past five years that’s the work that the Breakthrough Breast Cancer unit has been focusing on in Edinburgh. And it’s why Dixon and his team of Mike’s Marvels will be cycling from Glasgow to Edinburgh next month as part of Pedal for Scotland, raising money for Breakthrough to ensure research like theirs will continue to be funded.
“The money raised won’t necessarily come here,” he says as we sit in a meeting room in the oncology ward of the Western. “It won’t necessarily come to our research. I have no say in where it goes, I get no personal funding from Breakthrough. They fund the lab and the people in the lab, but not me. I’m here for the love of it. It’ll be up to Breakthrough where the money goes, but it will go to pay for the science.”
In the last four years Mike’s Marvels have raised £55,000 for Breakthrough. “I have many elderly patients who could never complete such challenges, patients who are too ill – so I do it in their stead.
“And it can be easier for me to raise money than patients. This is about the need. I’m merely a figurehead, it’s not about me.”
He adds: “I’m completely symbiotic with Breakthrough. I want to cure more people and to do that we need a better understanding of cancer. When you see patients die it is heartbreaking. Every day I walk past Amanda’s Garden here at the hospital. She [Amanda McCullough] died of an aggressive cancer in her thirties. She was a patient of mine. Nowadays we would do better for her, but there’s that consistent reminder that we couldn’t save her. Well you can see it’s not a hardship for me to go running or cycling for Breakthrough.”
Cancer research has already given women such wonder drugs as tamoxifen and Herceptin. Mike and his team – including Arran Turnbull, Andy Sims, Lorna Renshaw and Lorna Arthur – are focused on hormone therapies.
Around 75 per cent of women who attend the breast cancer units have cancer which feeds off oestrogen – a hormone. Drugs are given to cut that source of energy for the cancer, and in the majority of cases it works. But there are those women who become resistant to the treatment – they come back with secondary cancer – and those for whom it never works.
“We do a test to find out if a patient is hormone receptive or not, and then give hormone therapy. At the top end around 80 per cent will respond to that so we are trying to work on a test which will, with a high degree of prediction, be able to tell us which patients will respond to which hormone therapies and which won’t.
“We are testing two genes at diagnosis and another two, two weeks after a period of the hormone therapy. So we can see how the drug changes the cancer in that time. With these four genes we are 90 per cent certain we can target which patients will get the longest-term benefit from hormone therapies. And for those who won’t, we can immediately start looking at other options.”
Broadening the idea of more specific individual treatments, he adds: “Last year I collaborated with Professor Ian Kunkler on a study which involved giving no radiotherapy to elderly patients who were given hormone therapies and it was found the rates of recurrence of cancer after five years were very low.
“If you can show they will benefit from hormone drugs they might not need the more invasive radiotherapy. That’s what the test we’re developing could do. There are similar movements with chemotherapy and we’re collaborating with Chuck Perou, at the University of North Carolina.”
The trial has involved patients at the Western but also at the Royal Marsden which also has a Breakthrough unit. All in all, 147 women have been involved.
“There were 87 women at our end and I was the surgeon for every one of them. I did their operations and collected their tissues. We have to validate our research again and again, that’s why these things take so long. Of the breakthroughs we hear about every day one in a year might make a difference. We have to run tests over and over. That’s the work, it’s where Breakthrough’s money goes. Also when you’re dealing with testing genes, you’re talking about 20,000 of them and whittling them down to the ones which are causing the effects you’re looking for, in this case growth genes.
“What we have to be sure of is the test is reliable, works, and can be done cheaply. We believe this test does that because it can be done with the original biopsy taken when a patient first comes to us.”
The Breakthrough unit at the Western receives £80,000 per year for its research work from the charity, which itself relies solely on fundraising. Another reason for Mike to get on his bike.
He says: “I think lots and lots of people would want to take part in this cycle, in the way they do for fantastic events like the Moonwalk.
“The Marvels are indeed all marvels in themselves. Plastic surgeon Cameron Raine, who is a fantastic guy and a great collaborator with the surgical team, he’s on the cycle this year, and he did it last year too. You would think after spending hours together in surgery we wouldn’t want to see each other outside work, but it shows the strength of the team.
“It’s a great team. Clinician Lorna and I have worked together for 18 years. We’re in it for the long haul.”
• To sign up to Mike’s Marvels or to sponsor Mike please call 08080 100 200, or you can donate at justgiving.com/Mike-Dixon1 or by texting Marv80 GBP5 to 70070
Surgeon for 25 years to 50,000 women
FOR more than 25 years Professor Mike Dixon has been a breast cancer surgeon and it’s estimated he’s dealt with around 50,000 women.
He says: “Ten thousand women come through our screening clinic every year and I see about 2000 of them, so over the years it adds up. But they all have a different story and that’s how you remember them. And you remember them because you are interested and because you care.”
His story began in Sheffield. Son of a steelworker and shop-worker, his parents both wanted more for him and his sister and put a huge emphasis on education as a way out of poverty. By the time he was 16 he had enough qualifications to get into university.
Instead he left school to work as a DJ and hospital porter for 16 months at Sheffield Northern General. Then he applied to medical school in Edinburgh – working as a nursing auxiliary for two summers.
After graduating he went on to become a senior house officer in 1980 at the breast unit in Longmore Hospital in Newington, before moving to Oxford for more training. He was soon back as a senior trainee and 18 months later was made a consultant and was employed by Edinburgh University for five years before moving to the NHS. He has recently turned 60 and he and his wife have two grown-up sons – one an actuary, the other in engineering.