StatementThe Hamburg statement: the partnership driving the European agenda on breast cancer
Introduction
Breast cancer is the commonest cancer and the most frequent cause of cancer death in women throughout Europe. However, mortality from breast cancer is decreasing as a result of concerted action by all parties involved (women at risk, doctors, nurses, researchers, patients, journalists etc.). Partnership is paying off. Increasing numbers of breast cancer patients may nowadays achieve a normal life expectancy [1].
All previous European Breast Cancer Conferences produced Statements that became important tools in communicating with politicians and the media and we want to continue building upon this successful approach. Previous statements (Florence, Brussels and Barcelona) addressed the importance of screening programmes, translational research, patient involvement, risk assessment and the need for breast cancer to be managed in multi-disciplinary clinics (breast units) according to the guidelines recently approved by the European Parliament [2]. The Fourth European Breast Cancer Conference in Hamburg reached a consensus on key issues during the closing plenary session on the 20th March 2004. Clinicians, scientists, advocates and health-care consumers representing 3599 participants used a computerised voting system to formulate the Hamburg Statement.
The delegates of the 4th European Breast Cancer Conference wish to give priority to the following four areas:
Section snippets
Academic research
Excessively rigid legislation, unjustifiable administrative restrictions and government budget cuts are threatening cancer research in general, and breast cancer research in particular. In addition, the new European Directive on clinical trials might exacerbate this by leaving cancer research almost entirely to the initiative of the pharmaceutical industry. Whilst not denying the contribution of those pharmaceutical companies engaged in new drug development, the participants in the 4th European
Individual risk assessment
Women increasingly want to know about their individual risk of developing breast cancer [5]. All breast units should put in place special clinics for the assessment of individual risk and develop research in the field. Counselling should include a discussion of all proven risk-reducing measures, their availability within the relevant health-care system and assistance in privacy protection. As risk-reducing interventions are being developed, the issue of their availability, at no cost to the
Age limits
Most diagnostic and treatment protocols and procedures in breast cancer have age limits, but evidence is lacking for most of these limits. The 4th European Breast Cancer Conference wishes to draw attention to the growing size of the elderly population and their special needs, and proposes that participation in clinical trials is decided according to physiological status rather than age and that no upper age limit is laid down in the design of standard prevention and treatment plans.
Care after breast cancer
The 4th European Breast Cancer Conference recognises the need to redefine the concept of care for breast cancer patients after primary treatment. Routine continuous follow-up, as currently practised, does not serve women well. Care after breast cancer should not just aim at detecting local relapse and second primary tumours, but should also include psychological support and the management of treatment side-effects.
On the other hand, no consensus seems to exist on the duration and frequency of
Conclusions
Breast cancer incidence is increasing, and deserves priority. The four aspects addressed in this document: academic research, assessment of individual risk, breast cancer in the elderly and care after breast cancer represent major issues in breast cancer management. Research is fuelling progress, and clinical trials and translational research must be supported. Increasing knowledge of risk assessment should be translated into comprehensive individualised approaches. Better care should be
Acknowledgements
The authors thank P. Therasse, H. Meijers-Heijboer, M. Aapro and N. Roche for their input to the statement and their participation in the Final Round Table Session at EBCC-4. This Statement is also endorsed by the European Organisation for Research and Treatment of Cancer Task Force Cancer in Elderly (EORTC TFE) and the International Society for Geriatric Oncology (SIOG). The authors gratefully acknowledge the valuable contribution of Kris Vantongelen (Conference and Project Manager, Federation
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