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Monday, October 10, 2016

The challenge

DESIREE Communication Team

Breast cancer is the most common and most deadly type of cancer affecting woman in the EU countries, with more than 460,000 new cases and 130,000 deaths in 2012 (EUCAN2).

Multidisciplinary Breast Units (BUs) were introduced in order to deal efficiently with breast cancer cases, setting guideline-based quality procedures, clinical decisions on cases based on consensus and a high standard of care. BUs consists of a multidisciplinary team of clinicians, including medical oncologists, surgeons, radiologists, radioncologists, pathologists and other profiles that periodically meet to discuss new and ongoing cases in order to take therapeutic decisions.

Despite the evident advances, daily clinical practice and case presentation in the BUs is hampered by the complexity of the disease, the ever-growing amount of patient and disease data available in the digital era, the difficulty in coordination, the pressure exerted by the system and the difficulty in deciding on cases that guidelines do not reflect. 

The amount of data generated for every case may be overwhelming. A single case usually lasts for months or years, with repeated cycles of diagnostics and treatments. The associated digital information generated is increasing exponentially. Medical images may consist of complex datasets, sometimes including 3D modalities such as Computed Tomography or Magnetic Resonance with increasing resolution and different sequences providing complementary information. Digital pathology slides of tumor samples are starting to be commonplace, with the advent of whole-slide imaging digitalizing the whole sample in a huge mosaic.

Furthermore, the advent of the massive sequencing era, is starting to provide crucial information allowing to characterize the tumor (tumoromics) or the possible reaction of the patient to the drug (pharmacogenomics). The potential of exploiting this information and comparing it with other cases is enormous.

Furthermore, clinicians have to keep up-to- date with an overwhelming amount of studies, evidence and new therapeutic options. What is worse, clinical guidelines, based on strong evidence, lag about three years behind the state-of- the-art in diagnostic and treatments that already impact every day care. Still, there are many gaps regarding the applicability of a specific treatment on a given patient, as clinical trials only represent a limited spectrum of the population the drug is targeting.

Clinicians in the BU have to deal with all this information during case presentation, creating a picture of the patient and a mental map of knowledge, and take a therapeutic decision, sometimes clear, sometimes uncertain, in a time span that may range from 3 to 10 minutes, most of the times with the only help of a few pictures.

The advent of the BUs has had an important impact in oncology practice, but may drown in an intractable amount of data. This is where DESIREE will come to the rescue…

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This project has received funding from the European Union´s Horizon 2020 research and innovation programmme under grant agreement No 690238