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Article: Report on vaccines to prevent hereditary cancer

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Contents

What the segment was about Clinical trials                       
More research is needed      Guidelines            
State of vaccine research Questions to ask your doctor   
Other research Resources


What the segment was about

Good Morning America aired a segment entitled “Can a vaccine help prevent breast cancer at its earliest stages?”  The segment featured women who underwent risk-reducing mastectomy and discussed early research on preventing cancer. They interviewed Douglas Hager, PhD, who described research on cancer prevention. The story goes on to discuss a preliminary plan to develop a vaccine that prevents breast cancer from occurring in people with mutations.  Hager and colleagues hope the vaccine will eliminate cells that are on the way to becoming cancer cells before cancer develops. While the potential vaccine was the focus of the story, Dr. Hager also mentions medications and other trials that could prevent cancer.  The reporter states that Hager and his colleagues identified a vaccine that has the “characteristics that will work best against BRCA-related cancers,” and noted that they may be able to begin clinical trials in 2 years. 

Preventing cancer is a passion for many in the community, so this story has led to many questions. It is impossible for a short Good Morning America piece to address all the questions people facing might have.  This XRAYS article addresses some of the questions and issues raised by members of our community about the state of this science.

More research is needed

While the story outlined some very exciting early research, it is important to remember that there are many steps from developing a potential vaccine in the laboratory to having one approved for use in healthy people. approval of a vaccine is the end result of years of discovery and development. This includes: early laboratory research to find vaccine “targets” within abnormal cells that won’t affect healthy cells; creating the vaccine that will bind with these targets; testing the vaccine’s safety and efficacy in animal models, and producing large quantities of the vaccine. Following laboratory research, the vaccine is then tested in humans in clinical trials. Clinical trials in humans are usually conducted in phases, which begin with testing safety and determining the dose that will maximize benefit while minimizing side effects. This phase is followed by larger trials which determine whether or not the vaccine is effective while further evaluating safety.

This process can take many years. One example of this process is the development of human papillomavirus (HPV) vaccines for prevention of cervical cancer. HPV types 16 and 18, the two types responsible for 70% of cervical cancers, were discovered in the early 1980’s.  During the 1990’s researchers definitively linked HPV infection to cervical cancer and identified unique HPV targets for HPV vaccines.  In 1999 the first HPV vaccine clinical trials began with the first report of efficacy (the vaccine was doing what it was supposed to do-prevent HPV infection) following in 2001.  The approved the first HPV vaccine for females in 2006 and for males in 2009—over 20 years after the first early research.

It is unclear from the Good Morning America story how far along this research is. The vaccine research cited in the story has not been published in a peer-reviewed journal, making it difficult for outsiders to evaluate or comment on the status of the research. We will continue to follow this research.

Cancer prevention studies need many participants and many years to complete.  People making decisions about cancer risk management now should consult their health care providers about their options in order to decide what is right for them.  

State of cancer vaccine research

The idea of a vaccine to prevent cancer has been around for many years and the HPV vaccines are a real-world result.  Cancer vaccines can be divided into four broad categories:

  • vaccines to treat cancer (there is one vaccine approved to treat prostate cancer)
  • vaccines to prevent cancer that has been treated from coming back
  • vaccines to prevent cancer-causing viral infections such as the vaccines to prevent cervical cancer (human papilloma virus) and liver cancer (hepatitis B virus).
  • vaccines to prevent cancer before it starts

The vaccine discussed in the Good Morning America story falls into the fourth category.  If it works, it would kill cells that are on the way to becoming cancer cells before cancer develops. The person who gets the vaccine would then be protected from developing cancer but they would still have the mutation and could still pass it onto their children. 

While there are currently no vaccines approved to prevent hereditary cancers before they start, recent research into how cancer develops has given researchers clues on how to develop one. One of the challenges in developing vaccines against is that the cancer develops from the person’s own cells, so the vaccine must be able to tell the difference between a healthy cell and one that is on the way to becoming a cancer cell. This is very different than the HPV vaccine describe above, which is more like a traditional vaccine which targets a virus.

Other vaccine research

The Good Morning America segment did not cover other groups trying to develop vaccines to prevent BRCA-related cancers. A research group at the Basser Center for at the University of Pennsylvania led by Robert Vonderheide, MD, PhD and David Weiner, PhD have been studying a new vaccine that could someday prevent BRCA-related cancer in healthy mutation carriers 2,3. They are vaccinating patients with early cancers that are at high risk for recurrence in order to understand the safety and immunogenicity (whether the vaccine is reacting to the target molecules) of the vaccine in these patients. While not all patients in this clinical trial are mutation carriers some are. Once this early study is completed, the goal of the next study would be to vaccinate unaffected mutation carriers to look at safety and immunogenicity in this population. If that looks good the final step would be a large study to look at the risk of developing cancer following vaccination. 

FORCE will keep the community updated on results of vaccine trials and other prevention studies for people with mutations and other genes that increase risk for cancer.

affects men too  

The Good Morning America story featured two sisters affected by mutations talking about their choices for managing cancer risk and their hopes for their young daughters. The story did not mention that men also carry mutations and can pass the mutation on to their sons or daughters. Men with mutations in have an increased risk of male breast cancer, cancer (which usually occurs at younger ages than the general population and can be more aggressive), and pancreatic cancer. Men with family members who have mutations in or who have a strong family history of breast or ovarian cancer should consult with a genetics expert to discuss genetic testing. Current strategies to manage cancer risk can be found here.

Research on prevention depends on clinical trials

People facing often want better options for themselves and their families.  New forms of screening and prevention require rigorous clinical trials. These trials cannot be completed without mutation carriers who are willing to participate.  If you are interested in participating in ongoing trials for cancer screening or prevention, please see our Research section for studies near you. 

Posted 8/01/17

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Reference

Good Morning America. Can a vaccine help prevent breast cancer at its earliest stages?


Disclosure

FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board prior to publication to assure scientific integrity.

This article is relevant for:

High risk women who have not had breast cancer

This article is also relevant for:

People with a genetic mutation linked to cancer risk

Previvors

Be part of XRAY:

Expert Guidelines
Expert Guidelines

The National Comprehensive Cancer Network (NCCN) provides breast cancer risk management guidelines for people with and mutations. We recommend that you speak with a genetics expert who can look at your personal and family history of cancer and can help you to determine the best risk management plan. 

Screening for women:

  • Learn to be aware of changes in breasts beginning at age 18.
  • Clinical breast exam every 6-12 months beginning at age 25.
  • Annual breast  with contrast (or  if  is unavailable) beginning at age 25 and continuing until age 75.
  • Annual  at age 30 until age 75 (consider 3D  if available).
  • Screening after age 75 should be considered on an individual basis.

Risk reduction for women:

  • Women should have a discussion with their doctors about of the advantages and disadvantages of risk-reducing mastectomy.
    • Research has shown that risk-reducing mastectomy can lower the risk for breast cancer in high risk women by about 90%. Despite this, mastectomy has not been shown to help high risk women live longer.
    • Even after mastectomies, some breast tissue-and therefore some breast cancer risk remains. 
  • Women should have a conversation with their doctor about the possible benefits of tamoxifen or other estrogen-blocking drugs to reduce breast cancer risk in women with  mutations. Research on the benefit of these drugs to reduce breast cancer risk in women with  mutations has been mixed.

Risk management in men:

  • Breast self-exam training and education beginning at age 35.
  • Clinical breast exam every 12 months beginning at age 35.
  • In men with enlarged breasts, (gynecomastia) consider annual  in men with gynecomastia beginning at age 50 or 10 years younger then the earliest case of male breast cancer in the family (whichever comes first). 

Updated: 12/14/2021

Expert Guidelines
Expert Guidelines

The National Comprehensive Cancer Network (NCCN) provides guidelines for management of breast cancer risk in people with inherited mutations linked to breast cancer. We recommend that you speak with a genetics expert who can look at your personal and family history of cancer and help you to determine the best risk management plan. 

or

  • Begin yearly mammograms at age 40, or earlier based on the family history of breast cancer.
  • Consider yearly with contrast beginning at age 30-35.

, or  

  • Beginning at age 40 (or earlier based on family history):
    • recommend yearly .
    • consider yearly breast  with contrast.

  • No specific breast cancer screening guidelines. Risk management should be based on family history of cancer.

 

  • Beginning at age 30 (or earlier based on family history):
    • recommend yearly .
    • consider yearly breast  with contrast.
    • discuss risk reducing mastectomy. 

  • Beginning at age 30 (or earlier based on family history):
    • recommend yearly .
    • recommend yearly breast  with contrast.
    • discuss risk reducing mastectomy. 

  • Beginning at age 18, learn to be aware of changes in breasts.
  • Begining at age 25:
    • clinical breast exam every 6-12 months beginning at age 25 (or 10 years earlier than the youngest age of onset in the family).
  • Beginning at age 30:
    • yearly and breast with contrast beginning at age 30-35 (or 5-10 years earlier than the youngest breast cancer in the family).  

RAD51C/RAD51D

 

  • Yearly  beginning at age 40 or 5-10 years younger than the earliest age of diagnosis in the family (but no later than age 40).
  • Consider yearly breast with contrast beginning at age 40 or 5-10 years younger than the earliest age of diagnosis in the family.

  • Beginning at age 30:
    • clinical breast examination by a health care provider every 6 months starting at age 30.
    • recommend yearly .
    • recommend yearly  with contrast.

  • Beginning at age 18, learn to be aware of changes in breasts.
  • Beginning at age 20:
    • clinical breast examination by a health care provider every 6 months.
    • recommend yearly breast  with contrast beginning at age 20 or at the age of earliest breast cancer diagnosis if there is a history of breast cancer before age 20 in family.
  • Beginning at age 30
    • recommend yearly
  • Consider risk reducing mastectomy.

Updated: 09/22/2022

Questions To Ask Your Doctor
Questions To Ask Your Doctor

  • Which cancers am I at elevated risk for?
  • What are my options for managing my cancer risk?
  • I had breast cancer before age 45, should I consider genetic testing?
  • How can I find a cancer prevention clinical trial?

Open Clinical Trials
Open Clinical Trials

The following are breast cancer screening or prevention studies enrolling people at high risk for breast cancer.   

Additional risk-management clinical trials for people at high risk for breast cancer may be found here.

Updated: 01/10/2023

Peer Support
Peer Support

FORCE offers many peer support programs for people with inherited mutations. 

Updated: 08/06/2022

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