Department of Clinical Sciences Lund, Surgery, Lund University, Lund, Sweden.
Department of Surgery, Skåne University Hospital, Lund, Sweden.
Br J Surg. 2018 Jan;105(2):e158-e168. doi: 10.1002/bjs.10741.
Selection of systemic therapy for primary breast cancer is currently based on clinical biomarkers along with stage. Novel genomic tests are continuously being introduced as more precise tools for guidance of therapy, although they are often developed for specific patient subgroups. The Sweden Cancerome Analysis Network - Breast (SCAN-B) initiative aims to include all patients with breast cancer for tumour genomic analysis, and to deliver molecular subtype and mutational data back to the treating physician.
An infrastructure for collection of blood and fresh tumour tissue from all patients newly diagnosed with breast cancer was set up in 2010, initially including seven hospitals within the southern Sweden regional catchment area, which has 1.8 million inhabitants. Inclusion of patients was implemented into routine clinical care, with collection of tumour tissue at local pathology departments for transport to the central laboratory, where routines for rapid sample processing, RNA sequencing and biomarker reporting were developed.
More than 10 000 patients from nine hospitals have currently consented to inclusion in SCAN-B with high (90 per cent) inclusion rates from both university and secondary hospitals. Tumour samples and successful RNA sequencing are being obtained from more than 70 per cent of patients, showing excellent representation compared with the national quality registry as a truly population-based cohort. Molecular biomarker reports can be delivered to multidisciplinary conferences within 1 week.
Population-based collection of fresh tumour tissue is feasible given a decisive joint effort between academia and collaborative healthcare groups, and with governmental support. An infrastructure for genomic analysis and prompt data output paves the way for novel systemic therapy for patients from all hospitals, irrespective of size and location.
目前，原发性乳腺癌的系统治疗选择是基于临床生物标志物和分期。新型基因组检测作为指导治疗的更精确工具不断被引入，尽管它们通常是为特定的患者亚组开发的。瑞典癌症基因组分析网络-乳腺（SCAN-B）计划旨在为所有乳腺癌患者进行肿瘤基因组分析，并将分子亚型和突变数据反馈给治疗医生。
2010 年建立了一个从所有新诊断为乳腺癌的患者中收集血液和新鲜肿瘤组织的基础设施，最初包括瑞典南部地区的七个医院，该地区有 180 万居民。患者的纳入是纳入常规临床护理的，在当地病理科收集肿瘤组织并运往中央实验室，在那里开发了快速样本处理、RNA 测序和生物标志物报告的常规程序。
目前，来自九家医院的 10000 多名患者已经同意纳入 SCAN-B，来自大学和二级医院的纳入率都很高（90%）。肿瘤样本和成功的 RNA 测序正在获得超过 70%的患者，与全国质量登记处相比，表现出极好的代表性，是一个真正的基于人群的队列。分子生物标志物报告可以在 1 周内提交给多学科会议。
在学术界和合作医疗团体之间的果断共同努力以及政府的支持下，收集新鲜肿瘤组织的基于人群的方法是可行的。基因组分析和快速数据输出的基础设施为所有医院的患者提供了新的系统治疗方法，无论其规模和位置如何。
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