Precision medicine is providing new hope to patients and their families in Qatar, utilising international and local medicine-based evidence with Qatar’s unique genetic profile as the basis for a plethora of studies.
Speaking at the inaugural “Women in Science: The Journey toward Precision Medicine” conference held by Sidra Medicine – a member of Qatar Foundation (QF), Dr Salha Bujassoum, senior medical oncologist at Hamad Medical Corporation (HMC)’s National Centre for Cancer Care and Research (NCCCR), provided frontline insights into how Qatar’s national research efforts and clinical services have advanced and how collaborative efforts in Qatar are improving survival rates and revolutionising treatment.
Breast cancer is a leading cause of cancer-related deaths worldwide, and the most common malignancy among women in Qatar, accounting for 31% of cancer cases in women.
The risk of women in the population developing breast cancer is 56 per 100,000.
Dr Bujassoum highlighted how researchers at the HMC’s NCCCR, Sidra Medicine, QF partner university Weill Cornell Medicine – Qatar (WCM-Q), and other research hubs are employing precision medicine to transform the understanding of breast cancer prevention, diagnosis and treatment.
“Precision medicine is a strategy for disease treatment and prevention that considers individual variability in genes, environment and lifestyle – it’s about using genetic biomarkers to switch from one-size-fits-all treatment to a personalised approach,” she said. “Biomarkers are very important so we can apply systemic treatment for high-risk patients, and with this we can improve survival.”
“Survival is linked with early diagnosis and also the introduction of targeted treatment early on,” Dr Bujassoum stressed. “Precision medicine aims for optimised tumour response to treatment combined with the preservation of organ function and, thus, quality of life.”
“The concept of an individualised approach is not new in the field of breast cancer; however, recent advances in genomic medicine allowed more personalised approaches,” she added.
A better understanding of breast cancer molecular sub-types is enabling doctors to reduce their reliance on chemotherapy, with its savage side-effects, and instead look to new options such as immunotherapy, which helps the body’s immune system to attack cancer cells, as well as hormone therapy and drugs that directly target the tumour.
Earlier this year, Sidra Medicine, in collaboration with the QF’s Qatar Genome Programme – the largest genome project in the Middle East – published their study in *The Lancet Oncology regarding genetic variation in cancer-susceptibility genes in the Qatari population.
The study reported a high degree of heterogeneity for cancer predisposition genes and polygenic risk scores across ancestries in this population from Qatar, information which can inform the implementation of national cancer preventative medicine programs.
Funded by the QF, the study also involved the WCM-Q and the Qatar Computing Research Institute (QCRI), part of the QF’s Hamad Bin Khalifa University.
Speaking on breast cancer prevention, Dr Bujassoum described how the NCCCR launched its high-risk screening clinic in 2013 to cater to patients with a hereditary predisposition to breast and ovarian cancers, which was expanded in 2016 to manage patients at high risk for other hereditary cancers.
“In terms of prevention, we are applying risk reduction strategies not only for the person who has the relevant gene mutation but also members of their families, and we are doing this routinely,” Dr Bujassoum said.
“The median age of diagnosis for our breast cancer patients is 47 years old, and around 30% of cases are diagnosed below the age of 40 years; young onset breast cancer is typically a more aggressive disease than that experienced by older women,” she said. “We have a young population compared to the rest of the world, but it’s also true that we have a younger population with cancer, not only of the breast, but other cancer sub-types.”
“Clearly, we need to intensify our research targeting the younger population for a better understanding of the causes,” Dr Bujassoum added.
She emphasised that early diagnosis and better treatment rested on a combination of effective clinical care, education and research.
Dr Bujassoum lauded the efforts of international organisations such as the World Health Organisation (WHO) to explore the disparity between the prognosis for breast cancer patients in different countries and the efforts of different institutions within Qatar who have been collaboratively working with the HMC in multiple research projects regarding precision medicine in breast cancer.
“The major risk factor for cancer in general is decreased physical activity, which creates obesity, and there is a growing body of research about the microbiome, as well as the link between Vitamin D deficiency and incidence of malignancy,” she said. “So, we need to look to modifiable risk factors in our local communities and study these in our populations and consider how we can decrease risk by modifying lifestyle.”
More research is needed into the social and cultural barriers that prevent women from coming forward for screening and treatment, as well as an emphasis on culturally appropriate messaging.
Dr Bujassoum said that medical practitioners throughout the Middle East are more likely to see patients who had progressed to an advanced stage of cancer before seeking treatment, possibly due to lack of education, fear and denial.
Some patients mistakenly believe that, if they are not in pain, they are unlikely to have a malignant tumour.
And it is not just patients in need of education – we also need to engage our community healthcare providers to better understand the signs and symptoms of breast cancer.
“This is one of the areas of research that we need to focus on: what are the barriers to coming forward and seeking medical advice? Education and awareness are so important,” Dr Bujassoum said.