More And Better
The hug between iMM and Laço - a conversation with consultant Lynne Archibald
Lynne Archibald is one of the persons responsible for the existence of the former Laço association, a non-profit association aimed at raising awareness of breast cancer, calling for and promoting its prevention, diagnosis, and treatment.
The pink ribbon symbol emerged in the 1990s in the USA, created by Estée Lauder and Self magazine. Once it was spread throughout the world as a universal image, the Laço association created its name and brand image.
She talked to us a few months ago to inform us that the Laço association, together with the iMM - João Lobo Antunes Institute of Molecular Medicine, had created a new project, the iMM-Laço Fund: On the way to a cure. She also explained that, with the official closure of the Laço association, the project was being managed by the João Lobo Antunes iMM, considered one of the best research institutes in the country. At the time, she added that talking about breast cancer prevention is not a straightforward matter and that this justified the paradigm shift, but we'll get to that. After talking to Lynne Archibald, we realised that we needed to better understand what breast cancer really is and what issues are yet to be revealed.
She was born in Toronto, Canada, she's 54 years old, and now she's also a little bit Portuguese. She'd never heard positive things about the country where she's currently spending most of her time. She studied International Relations in the USA and wanted to study for a Master's degree in Europe; only then would she return to Canada, where she intended to live and get a Law degree. She went to London in 1988, to the London School of Economics to study for a Master's degree in International Relations. There she learned that "the plans we have for ourselves are not always the plans the universe has for us" and, instead of following the curricular path, she followed her heart. She met a young doctor who was studying for his PhD and thought he as the popular Italian everyone was talking about, but he turned out to be Portuguese. Some time later, he became her husband and Portugal became her new country of residence.
She remembers that, when she arrived, in 1989, the country was far from being what it is today - "there was no highway to Porto and there were only two TV channels".
Lynne didn't want to stay in Portugal without achieving financial independence. She taught English at the American Language Institute for 2 years, and while she was teaching others to speak her language, she was learning a language that she still says she can't fully master. She knew how "to order a coffee, a ham and cheese toast and say thank you", but that was it; After a number of unsuccessful group lessons, she chose to have private lessons, which eventually allowed her to reach the level of proficiency she has today.
After the birth of her second child, Lynne lost a great friend to breast cancer; after an apparent recovery, she didn't make it when the cancer returned two years later. So, in 2000, the end of Brigitte Cabral's life marked the beginning of Laço.
Was it because you lost this friend that Laço was created?
Lynne Archibald: Yes. We were a group of 5 women who didn't know each other well, but were very attached to this friend who died. And that's why we founded Laço, to honour her memory. She was only 42 years old and had two daughters. We did some research and realised that we could contribute to projects in Portugal. So we organised a luncheon to raise the first funds, which were the beginning of it all.
And what were those funds used for?
Lynne Archibald: To support the screening program that we realised was necessary. I should note that, for many years, Laço's main purpose was to support breast cancer screenings. At the time, and we're talking about 2000/2001, the investments made around the world were based on the idea that screenings and early detection of breast cancer would have a brutal impact on mortality. And it was quite logical to think that, when faced with a small problem, if we caught it as soon as it emerged, we could eradicate the disease. And that was true for most cancers.
And the screening meant what, undertaking medical exams?
Lynne Archibald: Yes, getting a mammogram. The screening was populational and organized, involving mobile units that travelled across the country every 2 years. They monitored women between 45/50 and 69 years of age and the idea was to create and keep a file to control each woman's case over time. Then, of course, there are individual "screenings" in which a woman gets a mammogram via her GP or gynaecologist, but this one was organised and institutional. The Portuguese League Against Cancer was our operational partner in many areas and the government reimbursed part of the costs, but our area of action was still geographically limited. We needed nationwide coverage, so Laço began financing the purchase of mobile mammogram units for the League. And across the world, Europe, Canada, USA, people were starting to talk a lot about breast cancer, encouraging women to look at their breasts. The message that was being sent across the world is that many women were dying of breast cancer because it hadn't been diagnosed in time. This meant that they wouldn't reach stage 4 of metastatic cancer because cancer was not allowed to develop. This was the theory.
And what did practice tell you?
Lynne Archibald: At the end of 2008/2009 there were a few retrospective studies that looked at the previous 20 years, when the screenings began. They started realizing that, despite the fact that there were advances in treatments such as hormone therapy, and that targeted therapy including trastuzumab (the first in a new group of drugs, monoclonal antibodies, which changed the treatment of breast cancer, moving towards the era of personalized treatment) for HER2-positive breast cancers that had not been treatable until then, was showing very good results, and that screenings were being used as a form of prevention, the truth is that the mortality rate had not decreased as expected. The idea we were trying to get across worldwide was that 90% of the cases that were discovered in time were curable. What the studies said was that even though the disease was treated in 30% of the women, years later it came back and when that happened the cancer was already metastatic. Which meant that the problem was inside the tumour and that the molecular biology of the tumour, its genetics, was what decided what was going to happen.
In other words, let me put this graphically to see if I understood it correctly, cancer, in this case, is like a plant and I can cut the stem, but the roots stays there. Then, it may either grow again or not.
Lynne Archibald: That's a fantastic image. Fortunately, this was the case with many cancers and that was it. But that's not the case with breast cancer. Our real confrontation was in 2012. It took us some time to accept the evidence. When the first study came out, I remember saying that it couldn't be true, that there was certainly a mistake there. But then another came out, then another. These were major international studies, which compared geographical areas where there had been screenings, with others where nothing had been done, and they realised that the mortality rates were fairly similar. What the screenings showed was that there were more cases of cancer, because they detected very small tumours, some of which might never grow or spread. So, when people tell me that the early detection of breast cancer is critical, I say it is, yes, but only for some types of cancer; of course it helps some women, but it is not helping all the women like we wanted to and believed it did. And what worried me when I managed Laço was that there was a huge investment in screenings, in time, in financial and human resources, a blind trust of women in the effectiveness of screenings and what we felt was that we were not meeting their expectations. That's why we created the Laço Grant, an annual grant that was granted for 3 years, precisely to go back to basics, and the basics are the biology of cancer. We realised that we hadn't found a cause for breast cancer and that there was nothing we could do to prevent it from appearing. We know that people with the BRCA 1 or BRCA 2 genetic mutation are much more likely to develop breast cancer and we also know that 30% of breast cancers recur and when they return they are already metastatic; but we don't know which ones or why. How many women did everything right and had metastatic breast cancer? By this I mean that our great concern is to try to understand how we can give these women more time to live, making their car, which is running off road at great speed, to slow down and come to a halt.
Are there real signs of hope for that?
Lynne Archibald:An article published in Nature Medicine in June this year says that there is a woman in the USA, Judy Perkins, who has metastatic cancer and a research group, and was able to develop a very specific immunotherapy process, only for her case, and showed that her illness has not progressed for 2 years, which is a very good sign. We feel that we're on the brink of many discoveries, but a lot of discoveries need to happen at the same time in order to touch the various cases we know. But of course we feel that we still haven't found a cure, because we still haven't discovered the mechanisms that explain why the cancer has that root you were talking about, something that is invasive, that spreads and spreads, waiting silently, for a long time. And that's what we're working on. One of the projects we're developing in our laboratory is Carmo Fonseca's project; she wants to get a better understanding of the genetic issues in order to find answers during the diagnostic. With this, I return to your question, we're going back to the source, to science, precisely because we felt we needed it, because there are things we can't solve merely by asking medical questions; we should also ask scientific questions, to understand breast cancer itself.
Why did you put an end to the Laço association as we knew it and chose to stay at the iMM?
Lynne Archibald: Sometimes, people find it difficult to let go of things; change is difficult and we cling to ideas and concepts. But the world is changing and so is the evidence. We feel that Laço had its moment but now we have to focus on other things, namely science and research. We've learned about science's role in medicine and we want to share this knowledge with the general public. The hospital can only apply what has already been tested in the lab, and we also want to show that. And while everyone knows what the hospital is and how it works, few know the laboratory and we want them to take share this learning journey, just as we did. We like and appreciate other research institutions, but we felt it was important for the CAML to be based here. A hospital, a medical school and a research centre are the three pillars of change for the future. Then, I should say that the iMM inspires respect and confidence, because it pays no attention to formalities, or to the packaging, but to the real content of the issues. Also because it opened its doors and let us come in and stay.
Incorporating the knowledge of one's own body was one of the great achievements accomplished by widespreadly talking about breast cancer; as Lynne tells us, "breast cancer was taken out of the closet and there is no longer any shame in talking about this female cancer without taboos, given that it's a breast and it had always had an erotic connotation"
The iMM-Laço Fund grants will continue to be granted annually to support researchers in the area of breast cancer, trying to fill the gap for those who are yet to obtain preliminary results and are unable not move forward on their questions and take the first steps, precisely because they lack early-stage funding. This "incubator for new projects" could thus work as leverage for other, more important, grants, while allowing "out-of-the-box" ideas to be developed. Twenty-five thousand euros was the target set to manage a project for one year and start the process of discovery. Several projects are funded every year and Sérgio de Almeida, Sofia Mensurado, and Rui Martinho were the winners in 2017. The call is open until the end of October for all those wishing to apply for 2018. But there is more good news, as the preliminary results of the winners of 2016 - researchers Sandra Casimiro and Karine Serre - have already been awarded more significant funding and were able to take their research a step further.
All those wishing to support the iMM-Laço Fund can participate in partner brand campaigns in October, Breast Cancer Awareness Month (Dama de Copas, Hotéis Real, Pioneer, ISDIN, Nestlé Fitness, Sorisa and Women’s Secret), or use the IBAN of the iMM-Laço Fund of the Institute of Molecular Medicine for bank transfers: PT50 0035 0824 0001188093042.