An interview with Shalini Singh, Chief Medical Partner Oncology Networks (Roche Diagnostics) and Steve Tuplin, Global Franchise Head for Breast & Gynaecological Cancers (Roche Pharma)
To begin with we asked both leaders what Breast Cancer Awareness Month (BCAM) 2022 means to them…
STEVE: Honestly, every day of my working week is breast cancer related, so every day is BCAM for me! The strength of BCAM in my eyes is its ability to raise the profile of breast cancer across the global community because where there is awareness, there can be action.
SHALINI: As a pathologist I am always interested in the ‘front end’ of innovation and how we can speed up this innovation to get to patients and the public faster. In the prevention of breast cancer, innovation starts with robust and accessible screening programmes, so BCAM is an opportunity to remind women to attend these vital screenings. We have seen what can be achieved in cervical cancer thanks to screening, and I am convinced we can do the same in breast cancer.
When we think about screening, a key question for me is how can we make access to screening easier for women? We know that screening is only one part of the picture in BCAM. In cervical cancer, the multimodal approach of screening, vaccination and treatment is helping tremendously towards the World Health Organization’s vision of eliminating cervical cancer as a public health concern. For the screening part, practical solutions like having people take their own samples for human papillomavirus (HPV) testing is one method that my team in diagnostics has developed to help expand access and we need to employ similar innovation in thinking for breast cancer.
STEVE: I totally agree. Ultimately, we need to make everything simpler and easier for women. Mammograms are a great screening technique but they’re static, you come to a certain place and that’s sometimes challenging for different parts of the population. I think making screening more accessible, by putting it in places where women live their daily lives, is vital.
SHALINI: Also, it's true to say that, during the COVID-19 pandemic, a lot of patients did not go for their regular screenings. Even though more people are coming through the doors in 2022, there is still a lag, and the impact on breast cancer screening and diagnosis is significant. Coupled to this stigma, historical disadvantages and a lack of awareness, means that COVID-19 sadly had a disproportionate impact on women, especially in low-to-middle income countries.
STEVE: Beyond COVID-19, there have always been disparities in cancer care that need to be tackled. What this means to me is that we need to make sure all our clinical trials better capture and reflect the patient population that is suffering from this disease. Thinking about black women for instance, they have poorer outcomes with breast cancer and are often underrepresented in studies. So how can we improve that? Then post-research and development, trying to improve equitable access and working with governments to strengthen local health systems and infrastructure.
SHALINI: Let’s think about how we can strive to improve women’s representation in healthcare more generally - I think we need to start with women at the heart of our development programmes and ask, ‘what are their needs now’, ‘what will they need in the future’, ‘how do they feel’? Instead of developing healthcare innovations that we think should work for them. It's a completely different mindset and that’s really the key.
You see this first-hand in breast cancer and cervical cancer. When the screening is done earlier the lesions are very small, and treatments can be effective. In the case of breast cancer, you can do a lumpectomy. And that can help a woman psychologically, in how she feels about her body, her recovery and her future health outcomes.
STEVE: If you really want to improve things from a women’s health perspective, taking screening away from individual disease-based screening to a more holistic women-centric approach should be the future. What if we could somehow marry the breast and cervical approach together to increase the amount of screening overall that is available to women in a single visit to a clinic?
SHALINI: Exactly, innovation in approach is key. Where that innovation goes for me in the future is diagnostic testing done in the comfort of the patient's home and where we can use digital and app-based technology to get results almost instantaneously. I see the next step in evolution for diagnostics being in digital and artificial intelligence.
STEVE: And while we have standard tests and standard treatments, there's a lot of women who are still not responsive to treatment. So what more can we do for these women? At Roche, we have a unique responsibility to move the needle here, thanks to our heritage in the area. I firmly believe that the next wave of improvement on our quest to cure cancer will come not only from treatment advances, but also from enabling even earlier detection and more precise interventions. That starts with better diagnostics – better tools to shape and drive the intervention.
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