The Sweden Cancerome Analysis Network - Breast (SCAN-B) Initiative: a large-scale multicenter infrastructure towards implementation of breast cancer genomic analyses in the clinical routine.
BACKGROUND
Breast cancer exhibits significant molecular, pathological, and clinical heterogeneity. Current clinicopathological evaluation is imperfect for predicting outcome, which results in overtreatment for many patients, and for others, leads to death from recurrent disease. Therefore, additional criteria are needed to better personalize care and maximize treatment effectiveness and survival.


METHODS
To address these challenges, the Sweden Cancerome Analysis Network - Breast (SCAN-B) consortium was initiated in 2010 as a multicenter prospective study with longsighted aims to analyze breast cancers with next-generation genomic technologies for translational research in a population-based manner and integrated with healthcare; decipher fundamental tumor biology from these analyses; utilize genomic data to develop and validate new clinically-actionable biomarker assays; and establish real-time clinical implementation of molecular diagnostic, prognostic, and predictive tests. In the first phase, we focus on molecular profiling by next-generation RNA-sequencing on the Illumina platform.


RESULTS
In the first 3 years from 30 August 2010 through 31 August 2013, we have consented and enrolled 3,979 patients with primary breast cancer at the seven hospital sites in South Sweden, representing approximately 85% of eligible patients in the catchment area. Preoperative blood samples have been collected for 3,942 (99%) patients and primary tumor specimens collected for 2,929 (74%) patients. Herein we describe the study infrastructure and protocols and present initial proof of concept results from prospective RNA sequencing including tumor molecular subtyping and detection of driver gene mutations. Prospective patient enrollment is ongoing.


CONCLUSIONS
We demonstrate that large-scale population-based collection and RNA-sequencing analysis of breast cancer is feasible. The SCAN-B Initiative should significantly reduce the time to discovery, validation, and clinical implementation of novel molecular diagnostic and predictive tests. We welcome the participation of additional comprehensive cancer treatment centers.


BACKGROUND
ClinicalTrials.gov identifier NCT02306096.
Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Medicon Village 404-A2, SE-22381 Lund, Sweden ; Lund University Cancer Center, SE-22381 Lund, Sweden ; CREATE Health Strategic Centre for Translational Cancer Research, Lund University, SE-22381 Lund, Sweden.
Lao H
LH
Saal
Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Medicon Village 404-A2, SE-22381 Lund, Sweden ; Lund University Cancer Center, SE-22381 Lund, Sweden ; CREATE Health Strategic Centre for Translational Cancer Research, Lund University, SE-22381 Lund, Sweden.
Johan
J
Vallon-Christersson
Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Medicon Village 404-A2, SE-22381 Lund, Sweden ; Lund University Cancer Center, SE-22381 Lund, Sweden ; CREATE Health Strategic Centre for Translational Cancer Research, Lund University, SE-22381 Lund, Sweden.
Jari
J
Häkkinen
Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Medicon Village 404-A2, SE-22381 Lund, Sweden ; Lund University Cancer Center, SE-22381 Lund, Sweden ; CREATE Health Strategic Centre for Translational Cancer Research, Lund University, SE-22381 Lund, Sweden.
Cecilia
C
Hegardt
Department of Pathology, Skåne University Hospital, SE-22185 Lund, Sweden.
Dorthe
D
Grabau
Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Medicon Village 404-A2, SE-22381 Lund, Sweden ; Lund University Cancer Center, SE-22381 Lund, Sweden.
Christof
C
Winter
Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Medicon Village 404-A2, SE-22381 Lund, Sweden ; Lund University Cancer Center, SE-22381 Lund, Sweden.
Christian
C
Brueffer
Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Medicon Village 404-A2, SE-22381 Lund, Sweden ; Lund University Cancer Center, SE-22381 Lund, Sweden.
Man-Hung Eric
MH
Tang
Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Medicon Village 404-A2, SE-22381 Lund, Sweden ; Lund University Cancer Center, SE-22381 Lund, Sweden ; Department of Clinical Sciences, SCIBLU Genomics, Lund University, SE-22381 Lund, Sweden.
Christel
C
Reuterswärd
Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Medicon Village 404-A2, SE-22381 Lund, Sweden ; Lund University Cancer Center, SE-22381 Lund, Sweden ; Department of Clinical Sciences, SCIBLU Genomics, Lund University, SE-22381 Lund, Sweden.
Ralph
R
Schulz
Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Medicon Village 404-A2, SE-22381 Lund, Sweden ; Lund University Cancer Center, SE-22381 Lund, Sweden ; Department of Clinical Sciences, SCIBLU Genomics, Lund University, SE-22381 Lund, Sweden.
Anna
A
Karlsson
Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Medicon Village 404-A2, SE-22381 Lund, Sweden ; Lund University Cancer Center, SE-22381 Lund, Sweden ; Department of Pathology and Cytology, Blekinge County Hospital, SE-37185 Karlskrona, Sweden.
Anna
A
Ehinger
Department of Pathology, Skåne University Hospital, SE-20502 Malmö, Sweden.
Janne
J
Malina
Department of Surgery, Lund University and Skåne University Hospital, SE-20502 Malmö, Sweden.
Jonas
J
Manjer
Department of Oncology, Skåne University Hospital, SE-22185 Lund, Sweden.
Martin
M
Malmberg
Lund University Cancer Center, SE-22381 Lund, Sweden ; Department of Laboratory Medicine, Division of Molecular Pathology, Lund University, SE-22185 Lund, Sweden.
Christer
C
Larsson
Lund University Cancer Center, SE-22381 Lund, Sweden ; Department of Surgery, Lund University and Skåne University Hospital, SE-22185 Lund, Sweden.
Lisa
L
Rydén
Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Medicon Village 404-A2, SE-22381 Lund, Sweden ; Lund University Cancer Center, SE-22381 Lund, Sweden ; Department of Oncology, Skåne University Hospital, SE-22185 Lund, Sweden.
Niklas
N
Loman
Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Medicon Village 404-A2, SE-22381 Lund, Sweden ; Lund University Cancer Center, SE-22381 Lund, Sweden ; CREATE Health Strategic Centre for Translational Cancer Research, Lund University, SE-22381 Lund, Sweden ; Department of Clinical Sciences, SCIBLU Genomics, Lund University, SE-22381 Lund, Sweden.
Åke
Å
Borg