Abstract
We read with interest the thoughtful analysis of current priorities in surgical breast cancer research by Ramsey Cutress and colleagues 1 on behalf of the Association of the Breast Surgery Surgical Gap Analysis Working Group. We value the authors’ concept of building a national project to identify open research questions in the field of locoregional treatment, a cornerstone of breast cancer therapy. Despite the large numbers of patients with breast cancer, the aims of surgical research are difficult to accomplish because of substantial obstacles that hinder ideas from being transformed into practice-changing data. First, clinical trials are almost exclusively initiated and done in different national settings. As a result, accrual of sufficient case numbers is difficult, time to completion (if reached) is unacceptably long, and underpowered trial results lead to statistical uncertainties. The limitation of research to separate national initiatives also leads to the simultaneous performance of very similar projects: three national randomised trials (SOUND 2 , INSEMA 3 , BOOG13-08 4 ) have independently been launched to investigate the omission of sentinel lymph node biopsy in patients with early breast cancer, and three other parallel trials (SENOMAC 5 , POSNOC 6 , SINODAR ONE 7 ) aim to confirm the safety of omitting axillary dissection in patients with a positive sentinel lymph node biopsy. Second, there are few opportunities to achieve cross-border funding for academic surgical research, especially when propagating de-escalating treatments. To overcome this fragmentation of European surgical research initiatives, a group of principal investigators leading major European trials founded the international collaborative non-profit initiative EUBREAST European Breast Cancer Research Association of Surgical Trialists (EUBREAST) in September, 2018. EUBREAST offers an independent scientific forum for its members to develop collaborative, cross-border research projects that draw synergy from leading European expertise, optimising resource utilisation, and joining efforts to achieve solid scientific results in the shortest possible period of time. Because of its multidisciplinary approach to breast cancer, EUBREAST embraces other diagnostic or therapeutic disciplines and broadens collaboration with existing networks, always with the aim of improving patients’ quality of life while maintaining or improving oncological outcome, with the goal of allowing patients to not only live longer, but live better.
