It is not unlike something that you’d see on a meat counter — a slightly more lurid red, perhaps, and not so bloody. But this is human flesh that could prove vital to medical research.
The pathologist from St Bartholomew’s Hospital, London, deftly aligns the breast tissue, guided by sutures that a surgeon has inserted to show which sides are top and bottom, front and back.
This apricot-sized sample has just been removed in the nearby operating theatre. Louise Jones, professor of breast pathology, puts it on a chopping board, takes a scalpel and cuts at the mark of a staple inserted by the surgeon to indicate the tumour site. Inside the sample she points out two paler patches, each about a centimetre across. This is the cancer — patches of denser cells almost invisible to the untutored eye.
She carefully divides the sample into two. One half is plunged into formalin, a preservative. Later it will be set into paraffin wax, sliced into wafer-thin sections, stained, then examined under a microscope to give doctors vital information about how to treat this patient’s cancer.
The other half is dipped into a flask of liquid nitrogen, sizzling from red to pink. Then, with a tinkle, it goes into a plastic tube that is put into an insulated container. In a few minutes it will be logged into the database and put into a freezer at -80C in a swipe card-protected storage facility elsewhere on the Barts site.
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One half for the patient, one half for scientific posterity. This breast tissue is precious not just because knowledge gleaned from it could help to save one patient’s life, but because it could eventually help to save the lives of thousands. It is among the first samples going into the world’s first breast cancer tissue bank, launched this month by Breast Cancer Campaign.
From now on, every breast cancer patient at the hospital who has tissue removed, whether because of biopsy or full mastectomy, will be asked if they consent to the part not needed for diagnosis of their cancer being kept for science. And every time the surgeons are ready with a tissue sample, Professor Jones will stop whatever she is doing and rush to the cell pathology lab to process samples before they deteriorate.
The half-sample for the bank must be frozen quickly so that in the future it can be examined in many ways (including DNA and RNA analysis) that conventional formalin preservation does not permit, although spare formalin-fixed tissue in wax blocks is also banked for some types of research.
Three other UK centres — at the Universities of Dundee, Nottingham and Leeds — are also part of the tissue bank and have started asking breast cancer patients if they want to donate.
Set up by the charity after five years of planning and a £3.5 million, investment, supported by Asda’s Tickled Pink and the Walk the Walk campaign, it will provide cancer scientists with a source of human tissue that they have never had before. Breast Cancer Campaign says it will revolutionise breast cancer research.
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What’s remarkable is that this has not happened before. For decades, UK breast cancer research has been held back by a lack of human tissue to examine. Cultured breast cells from rats or rabbits are often used instead.
In 2006 Breast Cancer Campaign gathered together 56 leading experts to review the gaps in research. They found that the biggest barrier to progress was lack of access to standardised, high-quality human tissue.
The problem arose partly because many hospitals don’t share the materials they keep, but mainly because of restrictive human tissue regulations introduced after the Alder Hey scandal in 1999. Collecting and keeping human tissue has become a very time-consuming and expensive business, normally way out of reach of NHS priorities and budgets —so most of it has been simply thrown away.
“The rigorous Human Tissue Authority regulations have had the benefit of making human tissue more valuable, involving patients in decisions to contribute and ensuring that samples are consistently collected and of good quality,” says Professor Jones, who is clinical senior lecturer at the Barts Cancer Institute and in charge of the Barts tissue bank. “The downside is that now most centres can’t afford to collect it. You need to make sure that patients understand and give their consent properly, then act quickly to bank the tissue, record data, and keep track of the tissue and the patient.”
The new tissue bank, launched last week at a Downing Street reception, will keep samples from about 800 patients annually. Each sample can be used in many studies.
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Breast Cancer Campaign will release tissue for research only when it is satisfied that a study is valuable and doesn’t overlap with work being done elsewhere. By tracking what research has been carried out on which tissue, and how each patient fares, tissue bank administrators will be able to help researchers to co-ordinate their work, translate it into treatments and find out what exactly makes cancers deadly.
Women with breast cancer are amazed that such a facility doesn’t exist already. Of 200 women who have already been asked for consent for breast tissue to be banked for research at Barts, just one has said no.
“Why wouldn’t you want it to be used?” says Deryn Howard, 49, who had a skin-sparing mastectomy at Barts last September. “If there is additional tissue after they have used what they need for your tests, it just makes sense.”
Howard, an office manager with a family history of breast cancer, was found to have three tumours in her left breast. Before surgery, she was asked about banking spare tissue for research. She agreed. She has now finished a course of chemotherapy and begins five weeks of radiotherapy this month.
“I’ve been an organ donor since my teens and I see it as an extension of that,” she says. “Medicine progresses through people participating. I have six nieces and one great-niece — and with my family history I’m concerned that if the research isn’t done, treatments won’t improve in the future.”
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Professor Jones shares her concern. “Despite decades of research, we still have only three biomarkers [chemicals that show the presence or state of a disease] for breast cancer, and we’re not very good at telling which cancers will become resistant to some treatments. We need tissue from a wide range of people to answer these questions.”
She shows me a paraffin wax block containing human cancer tissue, then hands it to me. It is like a small onyx paperweight, its marbling revealing layers and swirls of green-stained tissue. A small greyer patch is the tumour. It feels odd holding cancer in your hand.
All samples are kept anonymous, given codes rather than names, but donors can find out what their tissue has been used for. Deryn Howard knows that hers has already been used by Colan Ho-Yen, a researcher doing a study for Cancer Research UK at the Barts Cancer Institute.
Ho-Yen removed tiny “cores” of Howard’s breast tissue from a block similar to the one that I’m holding. One was biochemically analysed, another sliver was mounted alongside dozens of others in what is known as a “tissue microarray”. Ho-Yen could then examine them all under a powerful microscope, looking for similarities and differences.
The object of his interest is a particular receptor on the surface of some cancer cells, called a c-Met receptor, that seems to make them more likely to grow or spread. Ho-Yen is asking if new ways can be found to assess how active this receptor is by using a cheap test on all cancer patients. If so, it could help in getting the right drugs for the right patients.
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Ho-Yen has already used 200 human breast cancer specimens, but he will need about 2,000 to get a statistically significant cross-section.
“Lack of access to human tissue has been a major barrier to translating research into new treatments,” says Pamela Goldberg, the chief executive of Breast Cancer Campaign. “We felt a responsibility to act on it.”