Brussels Statement document
The European Breast Cancer Conferences (EBCC),
first held in Florence in 1998 and subsequently in Brussels in September 2000,
are the largest of their kind in Europe. They are not only different in their
size, but also in their outcomes. Driven by the desire for change of the
different participants, the conferences take 'political' decisions on the
future of breast cancer research, treatment and care, and then follow closely
their translation into reality by the three organising bodies.
Specifically, the conferences aim to bring about more
co-ordination in breast cancer research; more education of primary care
providers in breast cancer issues; and to sensitise politicians and women to
the problems surrounding the disease. A new and exciting era in breast cancer
research is dawning, and the opportunities are there to be grasped
On the last day of each conference, participants vote on the
preparation of a series of demands, and the organisers are required to report
back on their actions at the next conference, in this instance in Barcelona in
This Brussels Statement was formulated during the closing plenary
session of EBCC-2 on 30 September 2000 by clinicians, scientists and healthcare
consumers representing 3150 participants. It sets the agenda for the future
activities of the three major groups involved in breast cancer research,
treatment, prevention and advocacy:
The Breast Cancer Group of the European Organization for Research and Treatment
in Cancer (EORTC-BCG)
The European Society of Mastology (EUSOMA)
EUROPA DONNA, the European Breast Cancer
It is hoped that the objectives outlined in this document will
stimulate much-needed change in the field of breast cancer. EORTC-BCG, EUSOMA
together with the breast cancer advocacy activities of EUROPA DONNA, will work
towards these goals by lobbying European Governments and the European
Commission and by mobilising health-service providers, the scientific community
and the health care industry.
Breast cancer is the commonest cancer and the most frequent cause
of cancer death in women throughout Europe
. Because of its importance and its potential for successful
treatment, breast cancer deserves special attention and effort.
2. The Brussels conference makes the following statements:
2.1. Breast cancer should be managed in multidisciplinary
Following the Florence Statement
 which established that all women should have access to fully
equipped, dedicated breast units, the three Societies have produced European
Guidelines defining the requirements for such units. These European guidelines
stress the importance of multidisciplinarity (i.e. the collaboration between
surgeons, radiologists, clinicians, pathologists, etc.) and
multiprofessionality (i.e. the collaboration between doctors, nurses,
psychologists, social workers, etc.).
The Conference demands that national governments establish and
accredit breast units in their countries in accordance with the Guidelines and
ensure that breast cancer diagnosis and care are carried out in those units.
All breast units should develop quality assurance programmes
entering their data onto a common European database. The Conference pleads for
all the breast units to collect data on incidence and mortality and to pool
them in a common European database.
2.2. Breast cancer screening
The conference acknowledges the important contribution made by
mammographic screening to decreasing mortality and improving breast cancer care
. All women should be offered full information about the benefits
and risks of mammographic screening.
All European women between the age of 50 and 75 years should be offered
quality-assured mammographic breast screening free at the point of delivery.
Programmes should not be provided without adequate provision for assessment and
treatment of screen-detected abnormalities.
2.3. Quality assurance in breast cancer research
The Conference wishes to stress the importance of quality assurance procedures
as an integral part of the conduct of studies for all involved disciplines. It
invites health service providers and research funding agencies to consider the
additional cost for quality assurance procedures as an investment to obtain
Researchers and clinical investigators should recognise the
ethical and scientific necessity of always including quality assurance
procedures in their study protocols.
2.4. Risk assessment
The Conference wishes to bring to everyone's attention the
increasing potentials offered by new methods to assess breast cancer risk for
an individual woman and encourages researchers to identify a standardised risk
assessment methodology suitable for European women.
This will facilitate research in preventive measures such as
mammography and innovative imaging modalities, lifestyle modifications,
chemoprevention and prophylactic surgery
In addressing the issue of genetic testing, the Conference agreed
that not all women with a family history are at high risk and necessarily need
or want a genetic test.
Genetic testing should be provided only after receiving appropriate specialist
The Conference expresses the opinion that genetic testing should
not be encouraged in the absence of protective legislation against
2.5. Treatment tailoring
The Conference welcomes the progress made in tailoring treatment
programmes to individual patients and acknowledges the fact that a great
contribution to this progress comes from translational research (i.e. those
studies which result from the interaction between laboratory and clinical
The Conference wishes to assist in the coming years to a great
development of translational research in breast cancer by means of well-funded
research projects on frozen tumour specimens for which free circulation among
different countries should also be ensured.
Legislators on data protection are asked to facilitate this
scientific evolution by recognising the importance of these studies.
Informed consented collection of frozen tumour specimens should be
obtained from all breast cancer patients as a routine procedure.
2.6. Participation in clinical trials
Randomised clinical trials represent the most effective way of
evaluating new therapies, but also offer optimal treatment opportunities.
Positive steps should be taken to minimise obstacles to the participation both
for patients and clinicians.
Press, broadcasting media and Internet providers are invited to
increase awareness of the importance of participation in clinical trials as the
most important contribution to the progress of medicine and the best option for
maximum quality care.
Health authorities and research agencies should give adequate
support to national and international data centres conducting clinical trials
in breast cancer.
This statement sets the agenda for all those involved in breast
cancer research, treatment, care and advocacy.
The actions called for in the statement will be evaluated and reviewed in
Barcelona in March 2002.
The authors hope that, at that time, they will be able to report
positive changes which will improve the outlook for all those touched by breast
cancer, whether as patients, families, advocates, scientists or health
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"Brussels Statement on Breast Cancer"
M.Piccart, R.Blamey, M.Buchanan, L.Cataliotti, A.Costa, J.Cuzick,
G.Freilich, J.Jassem, C.J.H. van de Velde, R.Wilson, European Journal of
Cancer, Vol.37, No.11, pp1335-1337, 2001, reproduced with permission from