Research into cancer changes lives. But turning a discovery made in the lab into something that can benefit patients is a long and sometimes difficult process.

While some problems in research are technical, others centre on communication. And it’s not only when cancer hits the headlines that communication is important. As research changes our understanding of cancer, communication between scientists, doctors, policymakers and the public about the implications of new discoveries is absolutely vital.

Last month a conference at the British Library explored some of the problems in communicating cancer research, and ways to prevent the key messages from being ‘lost in translation’. Read on to find out about some of the ideas that came up, and you can also hear from the speakers in this video: 

The conference was organised by the National Cancer Research Institute (NCRI) Informatics Initiative, in partnership with the British Library. Professor Sir Ken Calman, chair of the NCRI, started the day with a focus on patients and the public, saying that we all want to be sure that changes in scientists’ thinking about cancer are acted on quickly and effectively.

From basic science to new treatments
A key concern at the conference was the need for more effective translational research in the UK – the process of taking a new idea from the lab all the way to clinical trials.

As we’ve blogged about recently, Cancer Research UK is funding 19 Experimental Cancer Medicine Centres across the UK that are helping to boost translational research and give more patients access to cutting-edge treatments. The ECMCs are jointly funded by Cancer Research UK and the NHS, and demonstrate how close cooperation between researchers and doctors can provide real benefits for patients.

Another hot topic was the increasing cost of research and new cancer drugs. Professor David Cameron (no relation!), director of the National Cancer Research Network, suggested that the economics of a new treatment should be considered earlier in the development process. Taking this approach could perhaps help to bring down the costs of new drugs – and the clinical trials needed to test them.

Clinical trials are an essential part of the process of bringing new treatments to patients. Professor John Gribben, director of the Centre for Experimental Cancer Medicine at Barts Hospital in London, said that better communication was needed to raise awareness of this – more patients should be able to find out about clinical trials as soon as they’re diagnosed with cancer. Cancer Research UK’s unique clinical trials database has led the way by making information about trials accessible to everyone.

The tricky issue of how to make better use of information about patients was also discussed. New technology from the NHS should make it easier for researchers to keep track of patients in the future, which could help us to learn more about the long-term effects of cancer treatment from the ever-growing numbers of cancer survivors in the UK.

Cancer in the media
As a new treatment makes the long journey from the lab to being approved for use in patients, it has  another hurdle to overcome – the media.

Dr Ben Goldacre, whose Bad Science blog and Guardian column have helped to expose many examples of poor science coverage, examined how cancer research is reported.

Dr Goldacre pointed out that the media can and do change the public’s health behaviour. The number of women attending cervical screening shot up after news of Jade Goody’s cervical cancer diagnosis, and Kylie Minogue’s diagnosis of breast cancer had a similar effect on the number of women asking for mammograms.

But is the power of the media put to good use? Dr Goldacre was concerned that new treatments are often badly reported – a study of press coverage of the cancer drug Herceptin found that only 14 per cent of articles had any mention of side effects. This kind of reporting could give patients a biased view of how much benefit they might get from a new treatment.

Dr Goldacre also said he thought the media did not give the best coverage to the strongest evidence. He gave the example of risk factors and cancer – every day there’s a new story claiming a particular food or activity can reduce or increase the risk of cancer, often with little evidence to back it up. Worryingly, a survey by the World Cancer Research Fund  recently found that 52 per cent of respondents thought that ‘scientists are always changing their minds’ about the things that cause or prevent cancer – despite the fact that advice on reducing the risk of cancer hasn’t changed in recent years.

Dr Goldacre’s message was that researchers and organisations communicating about cancer shouldn’t rely on the media to provide the public with evidence-based information. But he pointed out that many people are eager to find the real story behind the cancer headlines, making organisations’ websites – like ours –  a vital resource.

Indeed, the fact that you’re reading this blog right now is one example of how communication about cancer research is changing. Cancer Research UK not only funds research but also provides reliable information about cancer research for everyone – and we hope that our work will help to ensure that cancer research doesn’t get ‘lost in translation’.

Nell Barrie

The Sunbeds Bill passed its second reading in the Commons

Julie Morgan’s Sunbeds Bill passed its crucial Second Reading in the House of Commons on Friday.

The Bill seeks to prevent under-18s from using sunbeds, as well as opening the door to salons being compelled to provide accurate health information and prohibit unstaffed sunbed salons.

During the reading, Julie outlined why this Bill was needed, the evidence base behind it and also referred to research we’ve commissioned on sunbed use by young people. Julie was supported by long-term sunbeds campaigner Sian James, who spoke movingly about the experiences in her constituency of unstaffed sunbed salons.

There was a lively debate, and the Bill achieved warm cross-party support, with the Government’s Public Health Minister Gillian Merron congratulating Julie on the Bill and highlighting our press launch – previously featured on this blog.

No MPs opposed the Bill, and therefore it now passes to the next stage, the Committee Stage, without a vote.

What happens next?

The Committee Stage involves a small group of cross-party MPs, who over several meetings will look through the Bill line by line, and discuss its implications in detail.

The Bill will then have its Third Reading/Report Stage in the House of Commons, before being sent to the Lords for their approval.

Owing to the forthcoming general election, the timings are incredibly tight.  Hence we’re calling on the Government to make time for the Sunbeds Bill to be properly debated and passed before the election is called.

Henry

Alcohol causes at least seven types of cancer

This week, the Department of Health is launching a new advertising campaign to raise awareness of how alcohol can affect your health in the long-term.

Many of us are aware of the short-term effects of drinking too much – feeling sick, a hangover, a spot of embarrassment, a vague but hard-to-pin-down sense of guilt – but the long-term effects often slip under the radar. These include a higher risk of many cancers, heart disease, stroke and more.

Cancer Research UK is supporting the new campaign so we wanted to use this blog post to discuss some of the science around alcohol and cancer.

So is alcohol really linked to cancer?

Yes. Surveys tell us that only about a third of people realise that alcohol can increase the risk of cancer but actually the evidence in this area has been very strong for a number of decades.

The International Agency for Research on Cancer produces reports that are widely seen as the gold standard for working out what causes cancer and what doesn’t. They first said that there is “sufficient evidence” that “alcoholic beverages are carcinogenic to humans” way back in 1988. Since then, many more studies have been published. There are too many to list completely here, but this is a good review for the scientifically minded among you. IARC, incidentally, confirmed their ruling in 2007, and again last year.

Which cancers are affected? And how many?

Alcohol causes at least seven types of cancer, including cancers of the mouth, oesophagus (food pipe), pharynx (upper throat), larynx (voice box), breast, bowel and liver. There is also increasing evidence linking alcohol to pancreatic cancer.

Estimating the number of cancers that are linked to alcohol is always going to be a rough business. One analysis by IARC estimated that in Western European countries like the UK, around 5 per cent of cancers are linked to alcohol, which works out to around 15,000 cases a year. In the Oxford Textbook of Medicine, Professors Richard Doll and Richard Peto estimated that 6 per cent of cancer deaths in the UK are caused by alcohol, adding up to around 9,000 a year.

What level of drinking affects the risk of cancer?

There is a clear linear relationship between the amount of alcohol someone drinks, and their cancer risk. In other words, the more people drink, the higher their risk.

But cutting back drinking so you don’t feel drunk doesn’t mean you avoid risks to your health. Alcohol can increase the risk of cancer at levels too low to make an average person drunk. Studies have consistently shown that as little as three units a day – the amount in a pint of strong lager or a large glass of wine – can significantly increase the risk of mouth, oesophageal, laryngeal, breast and bowel cancers. At this level, the risks are fairly small but they get bigger the more you drink.

However, it seems that alcohol only increases the risk of liver or pancreatic cancers if people drink large amounts. This is because alcohol affects the risk of these cancers by causing cirrhosis or pancreatitis, conditions that are linked to heavy drinking.

Which is worse: binge drinking or spreading my drinking across the week?

We don’t actually know, and this is one of the big holes in the current evidence. Imagine someone who generally drinks nothing during the week but then knocks them back at weekends. So far, there’s not been enough research to tell if they have a higher or lower risk of cancer compared to someone who drinks the same total amount, but spread throughout the week.

There are hardly any published studies looking at the effects of different drinking patterns. One study suggested that weekend drinking had particularly strong effects on the risk of breast cancer, but it’s not conclusive in itself. As we said above, it’s the total amount that matters.

How high are the risks?

There’s a good meta-analysis (an overview of existing studies) that compares the effects of different levels of drinking on different cancer types. By collecting the results of previous studies, this analysis concluded, for example, that drinking 6 units a day (around 2 pints of strong lager):

• increases the risk of mouth cancer by 3 times (200 per cent)
• increases the risk of oesophageal cancer by 2 times (100 per cent)
• increases the risk of breast cancer by 55 per cent
• increases the risk of bowel cancer by 10-19 per cent

These figures are “relative risks”. They show how a person’s odds of developing cancer change as they drink, but they don’t tell you what those odds were in the first place. Those are called “absolute risks”.

For example, for a woman, the lifetime risk of breast cancer (the odds of developing the disease at some point in one’s life) is 11 per cent or 1 in 9. If that goes up by 55 per cent, the new absolute risk becomes 17 per cent or 1 in 6.

For a man, the lifetime risk of oesophageal cancer is 1.3 per cent or 1 in 75. If that doubles, the new absolute risk is 2.6 per cent or 1 in 38.

It is worth noting that breast and bowel cancer are far more common than mouth or oesophageal cancers so the absolute risk of developing these cancers is much higher. Even if that risk goes up by a relatively small amount, that translates to a large number of actual cases. For example, the Million Women Study concluded that if 1,000 UK women under the age of 75 drank an extra unit a day, they would develop 15 extra cancers, 11 of which would be breast cancer.

How do these studies actually work?

There are two main types. “Case-control studies” compare people with cancer to healthy people to see if differences in their drinking habits are linked to their disease. “Cohort studies” are generally stronger. They follow large groups of healthy people, collect detailed information about their lifestyle, medical history and more, and see what happens to their health over the course of years or even decades.

In both cases, it is important to collect information on other aspects of a person’s lifestyle that could also affect their risk of cancer. For example, if you were studying the link between alcohol and mouth cancer, it’s important to account for whether people smoked or not, since smoking is a major cause of mouth cancer and smoking and drinking often go hand-in-hand. Likewise, being overweight also causes cancer, and drinking alcohol can make people put on weight. These are called “confounding factors” and scientists use statistical methods to adjust for them. In this way, they can consider the effects of alcohol alone.

Typically, scientists measure alcohol consumption with questionnaires that ask people to report how much they drink. These questionnaires have an obvious drawback in that they rely on people being honest rather than playing down how much they drink – and indeed this is a criticism frequently levelled at studies of alcohol consumption.

But actually, it turns out that alcohol drinking is measured very well by questionnaires, at least for those used by the best and biggest studies.  For example, the Million Women Study validated their questionnaire by comparing it to a 7-day food diary where participants write down everything they eat/drink on a daily basis for a week. They found a good level of agreement between the two measures. The EPIC study validated its questionnaire against actual urine and blood samples and found that alcohol was actually one of the parts of people’s diets most accurately measured by the questionnaires.

How does alcohol actually cause cancer?

There are probably many answers to this question because alcohol does a lot of things in our bodies. First and foremost, your body converts alcohol into a toxic chemical called acetaldehyde – responsible for many of the symptoms of a hangover. But acetaldehyde can also damage DNA – it sticks bulky molecules onto the famous double-helix and prevents our cells from repairing this damage.

Genetic studies support this idea. Some people in East Asian countries, like China and Japan, have genetic faults that either make them better at converting alcohol to acetaldehyde, or worse at getting rid of acetaldehyde. Either way, they build up unusually high levels of this chemical when they drink. And when they drink, they have a higher-than-usual risk of cancer.

As well as producing acetaldehyde, alcohol can also boost levels of oestrogen in the body, which could explain the link with breast cancer. And it increases the odds of developing cirrhosis, which, in turn, causes liver cancer. Finally, it can also make it easier for the tissues of the mouth or throat to absorb other cancer-causing chemicals, such as those found in cigarette smoke.

Do all types of alcohol affect the risk of cancer? Even wine? What about red wine?

You’ll see from the section above that, as far as cancer goes, the harmful effects of alcohol are common to all drinks, rather than any specific type. All alcoholic drinks, for example, produce acetaldehyde in the body.

There are some disagreements. Take wine, for example. It is difficult to untangle the possibility that wine consumption could simply be linked to generally healthier lifestyles. Some studies have found that wine increases the risk of cancer to a lesser degree than beer or spirits, others have said that it has the same effect, and yet others have concluded that it’s particularly harmful when it comes to cancers of the mouth or throat.  For example, the Million Women Study found that women who only drank wine have similarly higher risks of cancer than those who drank all types of alcohol.

Red wine contains a chemical called resveratrol, which has some anti-cancer effects in laboratory cells. Many studies are looking at resveratrol as a possible drug for treating or preventing cancer, but as we’ve discussed elsewhere on this blog, this is a far cry from saying that red wine could protect people from cancer. A purified form of a chemical is not the same as the food or drink that contains it, and work in laboratory cells doesn’t automatically translate to effects in living people.

Isn’t some alcohol good for you?

There is evidence that drinking small amounts of alcohol can reduce the risk of heart disease in certain age groups. However, heavy drinking increases the risk of heart disease. Interestingly, a recent review of the global effects of alcohol estimated that alcohol causes twice as many cases of heart disease as it prevents.

We have to weigh up the heart disease effect against the links between alcohol and cancer, high blood pressure, some types of stroke, cirrhosis, liver disease, pancreatic disease and more. One analysis of 34 studies found that people who drink less than a unit a day have around 17-18 per cent lower risks of “total mortality”, which means that at any given age, they are less likely to die of any cause. These benefits disappear at roughly the level of alcohol drinking that the Government guidelines are set at.

It’s also important to realise that the benefits of light-drinking only applies to older age groups. According to one study, if you look at overall mortality, there is no beneficial level of drinking for women under 55 or men under 35.

The balance between the risks of cancer, heart disease and other conditions is why we are not suggesting that anyone avoids alcohol altogether. Instead, Cancer Research UK’s advice is to limit one’s drinking to one small drink a day for women (which is about two units a day) and two small drinks a day for men (about three to four units a day).

However, the important point is that, as we said above, there is a linear relationship between the amount you drink and your risk of cancer. This means that whatever you drink already, cutting down by some amount will help to reduce your risk. And, of course, doing so is entirely down to individual choice.

- Ed

Yesterday, we went to Downing Street to present the Save Your Skin petition to health minister Gillian Merron, who came to give Government support to the Bill.

The petition has been signed by over 10,000 people, and is backed by The Sun newspaper.

The huge support this petition has had is fantastic, and just shows how much the public want a law to protect children and teenagers from the dangers of sunbeds.

But crucially, we need MPs to come to the Second Reading of the Private Member’s Bill this Friday – without which this bill won’t go any further.

Please help us by asking your MP to support the bill – by emailing them through our CancerCampaigns website.

National Cancer Director, Professor Mike Richards

Late last year, the Department of Health announced a new pilot scheme to find out if computer programmes could help GPs to estimate a patient’s risk of cancer.

This is one of a number of measures that the Government, and organisations like us, are introducing as part of a drive to detect cancers at an earlier stage, when they are more likely to be treated successfully.

Professor Mike Richards, the National Cancer Director unveiled the move in an interview with the Guardian. The new computer software will consider factors like age, weight and symptoms, to work out if people are likely to have cancer and whether they should be referred to a specialist.

A typical GP only sees about 8 or 9 cases of cancer in a year – and most of these will be the most common types of the disease. Cancer shares many of its symptoms with other, less threatening illnesses and this can mean GPs have a difficult job spotting the many types of cancer at an early stage.

Speaking about the computer-assisted risk assessments, Professor Richards said, “GPs will welcome this because it will make their diagnoses quicker and better. Over time this will save lives.” But he emphasised, “The GP will always have the final say. If he wants to refer a patient to hospital, he will always have the right to do so.”

How do we compare?

Professor Richards superbly summed up why early diagnosis is important in a recent talk at the Royal College of Physicians in London. He noted that large studies have shown that the UK has poorer cancer survival rates compared to the best performing countries in Europe. Late diagnosis – where people’s cancer is at quite an advanced stage before they receive treatment – is thought to play a large role in this.

So what does the UK need to do to achieve world-class outcomes in cancer treatment?

First, Professor Richards defined ‘world-class’ as when ‘the overall burden of cancer in England would be as low as anywhere in the developed world’. So, essentially he wants to see the lowest number of people developing cancer in the first place, and the lowest number of people subsequently dying from the disease. And we need a high quality of care for people with cancer and good health and wellbeing for the growing number of people who survive the disease.

The latest figures for England, compared to the rest of Europe, show the proportion of men developing cancer is better than average and the numbers of men dying from cancer are average. But the proportion of women developing cancer – and dying from cancer – are worse than average.

So there is plenty of room for improvement – particularly among older people, where the number of people dying from cancer isn’t falling over time, in line with other western countries.

Richards quoted Professor Michel Coleman, who has estimated that “around 10,000 deaths within five years of a cancer diagnosis could have been avoided each year in Britain in the late 1990s if survival matched the best in Europe”.

In Richards’ opinion, “10,000 avoidable deaths per year is frankly unacceptable”.

What is the situation in the UK?

Richards pointed out that there are areas where the UK is doing well. Death rates from cancer have fallen by nearly 20 per cent since 1995, particularly among men under the age of 65.

Accordingly, this “reflects where we are with lung cancer epidemics”, where the number of male smokers has dropped dramatically over recent years. In fact, just 21 per cent of people in the UK still smoke (although this figure is as low as 14-15 per cent in other countries).

Death rates from cancer have also fallen among women, but to a lesser extent – this is consistent with the fact that the number of female smokers hasn’t yet fallen in the same way as the number of male smokers.

Our screening programmes are also “among the best in the world” due to our effective processes to invite people for screening. And UK waiting times have improved markedly over recent years.

But the proportion of people receiving curative and palliative treatments is still low compared to some other countries, Richards said. Addressing these areas could make a big difference in the future.

For example, the best way to treat a type of lung cancer called ‘non-small-cell’ lung cancer is to cut it out. While this isn’t always an option for advanced tumours, surgery is only used in around 10 per cent of cases in the UK, compared to 20 per cent in other countries.

We also use fewer anti-cancer drugs, around two-thirds of the level used in other countries, according to 2007’s Cancer Reform Strategy. But many of these drugs are used for palliative care and do not play a large role in increasing survival. A detailed study of drug use is underway to get comprehensive information on how we compare to other countries in terms of our drug use.

So why are we below the best?

Professor Richards believes it is a combination of factors.

For example, health service provision in the UK could be improved. Unhealthy lifestyles could also play a role, although this mainly affects the number of people who develop cancer rather than survival rates. Our investment in cancer services could also be improved, although it’s not clear what impact this will have.

Last year, the UK spent approximately 5 per cent of the NHS budget on cancer, well below the levels of other European countries, notably France (7 per cent) and Germany (9 per cent).

For the moment, it’s not clear why we are still lagging behind other parts of Europe, because there isn’t a lot of detailed data quantifying and comparing the contribution of different things.

Thankfully, these data are currently being gathered. However, Professor Richards said ‘A great deal of indirect evidence points to late diagnosis and low curative intervention rates as the major factor underlying poor survival in the UK’

What do we need to do about it?

Thankfully, as we’ve mentioned several times recently, there’s a renewed focus on early detection and symptom awareness. The NAEDI initiative, launched over a year ago, is now in full swing, and hard evidence is being collected and disseminated (there’s more information about NAEDI on our main website).

And finally…

Professor Richards said that if he could “wave a magic wand”, the most important change he would make is to emphasise the importance of prevention and early diagnosis. A lot has been done to improve the care that people receive after they are referred on to specialists but we can do a lot more to get people referred and diagnosed earlier to “bring survival rates up”.

New initiatives like NAEDI in England, and the cancer-risk assessment software, are positive steps to help tackle to problem, prevent avoidable deaths and put the UK on par with the rest of Europe. We would welcome a similar focus on early diagnosis in other areas of the UK.

Laura

This is a repost of an article from last year. A few stats have been updated, but the messages are the same. Despite a huge amount of coverage in the press, the standard tenets of healthy living still remain the best way of reducing the risk of cancer.

And what better time to start that in the New Year?

A diet high in fruit and veg can help reduce the risk of some cancers

Christmas means different things to different people. But it’s probably fair to say that to most, it can be summed up very eloquently in one phrase – ‘my eyes were bigger than my belly’.

It’s traditionally a time when we eat more than we would ever usually eat, drink more than we would ever usually drink, and, perhaps no wonder, collapse on the sofa more than we would ever usually collapse.

Thank goodness, then, that Christmas is followed by New Year and the chance to start afresh.

Resolutions are a big part of any New Year and when we make them, we often have our health in mind. But how many of us realise just how much good we’re doing? In this post, we’ll find out how familiar resolutions can help to dramatically reduce our risk of cancer.

Quitting smoking is the best present you can give yourself

Smoking – so last year

Here’s one we’ve all heard – “In the New Year I’m going to quit smoking”. How many of us would have been thinking about cancer when we made it? Probably not that many. Maybe, we were thinking about trying to get rid of a cough instead or being able to get to the top of the stairs without being out of breath.

Stopping smoking can certainly help with these problems, but on top of that, it also means reducing the risk of 15 different types of cancer – huge added value by anyone’s standards!

• Read our reasons to quit and pointers for how to go about it
• Find out answers to common questions about smoking
• Watch our films about the chemicals in cigarette smoke
• Order or download our free leaflet: Wish you could give it up?

Post-Christmas waistline

Keeping active can help prevent cancer

If carving the turkey was the most activity you got all Christmas, you might resolve to do more exercise now the New Year’s here, maybe to look a bit more toned or build those muscles. But keeping active, not just at the gym but at the ice rink, around the house or at work, can also help to reduce the risk of two of the most common cancers, breast and bowel. And it doesn’t even have to cost any money – gardening, brisk walking and other small bits of activity could be enough.

Not only that, being active helps in maintaining a healthy bodyweight – great news since current  levels of overweight and obesity in the UK could lead to 19,000 cases of cancer in the future. Keeping to a healthy weight isn’t easy, but we can help you to do it.

• Try our Ten Top Tips for some scientifically proven ways of keeping those pounds off through small changes in your everyday routine
• Check your Body Mass Index
• Order or download our free leaflet on body weight, activity and cancer
• Kick-start your new active year by running for Cancer Research UK

Too much pudding?

Alcohol increases cancer risk

Eating and drinking healthily is another big post-Christmas concern. It’s perhaps little wonder that, after the excess of Christmas pudding and mulled wine, cutting down on alcohol and eating more fruit, vegetables and fibre is really appealing. But resolving to eat more healthily can also help to reduce the risk of a range of different cancers.

• Order or download our free leaflets on the truth about food and cancer, and the link between alcohol and cancer
• Learn why alcohol affects the risk of cancer
• Learn about what counts as a portion of fruit and vegetables and how to get your five a day
• Read our tips for making healthier meals, avoiding ‘hidden calories’, cultivating healthier eating habits and making sense of food labels,

It’s your year

Who would’ve thought that the resolutions we hear so often around this time of year have the potential to do us so much good? Of course, turning the resolutions into reality is no easy task.

But if it doesn’t happen on the 1^st of January, don’t give up. Keep working at it. Any day can be the day to start afresh. Make 2010 your year.

Ed

2009 has been a busy year for our researchers

We’ll be taking a break from blogging over the festive period, but we’ll be back in January with more top science, myth-busting and podcasts.  In the meantime, here’s a quick run-down of some of the biggest stories that we’ve covered on the blog this year.

Going all the way back to January, our researchers discovered how the female sex hormone oestrogen can cause DNA damage. This could explain how it drives a number of cancers, including breast cancer and ovarian cancer.

February’s big excitement was the launch of the first Cancer Research UK Centre, in Birmingham.  We’ve now opened seven more Centres across the UK, and we’ll be announcing yet more in 2010.

In March, Cancer Research UK-funded scientists made progress in developing a nanoparticle-based treatment that can specifically target cancer cells.  Although there’s a way to go before this could be used to treat patients, this is the kind of innovative research that may well pay off in the future.

Showing that they’re certainly no fools, April saw our researchers reveal details of a simple test that could show whether relatives of bowel cancer patients are themselves at high risk of the disease.

And in May, promising early-stage clinical trial results were published for the prostate cancer drug abiraterone – a drug that Cancer Research UK helped to develop.

In June our scientists showed that humble adenoviruses – usually responsible for causing cold-like illnesses – can be altered to become cancer killers.

And the following month, the spotlight shone on our Gray Institute for Radiation Oncology and Biology in Oxford – where researchers announced that cancer cells appear to spread along blood vessels in the brain, rather than nerve cells as previously thought.  Their finding changes the way we think about how cancer spreads to the brain, and how we might develop treatments to prevent it.

In August our media spokespeople were kept busy commenting on an important breakthrough from scientists in the US, who might have found a way to target the faulty stem cells that are thought to lie at the heart of a number of cancers.

As the summer drew to a close, September saw Cancer Research UK-funded scientists make more progress in our understanding of the genes involved in cancer, as they revealed nine more gene variations linked to prostate cancer.

In October, cancer researchers from around the world descended on Birmingham for the annual NCRI Cancer Conference to hear about the latest scientific developments.

Judging by the buzz amongst delegates, new drugs called PARP inhibitors are set to be rising stars of treatment for breast cancer – and perhaps for other cancers – in the future.

After a year and a half of campaigning, our “Out of Sight, Out of Mind” campaign scored a huge victory in November, as the Health Bill 2009 – which bans the display of tobacco at the point of sale and prohibits tobacco vending machines – became law.

And despite December’s chill, our hearts were warmed last week by the announcement that scientists at the Wellcome Trust Sanger Institute had mapped the entire genomes of cancer cells from a melanoma and a lung cancer patient, as well as corresponding healthy cells.  Their groundbreaking work reveals detailed molecular insights into the development of cancer, and sets the scene for rapid progress in understanding how cancer develops – and hopefully how to treat it more effectively.

That’s just a brief round-up of some of the exciting progress that’s been made over the last twelve months – much of it a result of the hard work of our scientists, and supported by your generous donations.  Thank you so much.

And on that note of gratitude, we wish you a very merry Christmas and a happy new year – see you in 2010!

Kat

• Siim Pauklin, Isora V. Sernández, Gudrun Bachmann, Almudena R. Ramiro, Svend K. Petersen-Mahrt (2009). Estrogen directly activates AID transcription and function The Journal of Experimental Medicine
• Chisholm, E et al (2009). Cancer-Specific Transgene Expression Mediated by Systemic Injection of Nanoparticles Cancer Research, 69 (6), 2655-2662 DOI: 10.1158/0008-5472.CAN-08-2657
• Lubbe, S. et al (2009). Implications of Familial Colorectal Cancer Risk Profiles and Microsatellite Instability Status Journal of Clinical Oncology DOI: 10.1200/JCO.2008.20.3364
• Attard, G. et al (2009). Selective Inhibition of CYP17 With Abiraterone Acetate Is Highly Active in the Treatment of Castration-Resistant Prostate Cancer Journal of Clinical Oncology DOI: 10.1200/JCO.2008.20.0642
• Cawood, R., Chen, H., Carroll, F., Bazan-Peregrino, M., van Rooijen, N., & Seymour, L. (2009). Use of Tissue-Specific MicroRNA to Control Pathology of Wild-Type Adenovirus without Attenuation of Its Ability to Kill Cancer Cells PLoS Pathogens, 5 (5) DOI: 10.1371/journal.ppat.1000440
• Carbonell, W. et al. (2009). The Vascular Basement Membrane as “Soil” in Brain Metastasis PLoS ONE, 4 (6) DOI: 10.1371/journal.pone.0005857
• Gupta, P. et al. (2009). Identification of Selective Inhibitors of Cancer Stem Cells by High-Throughput Screening Cell DOI: 10.1016/j.cell.2009.06.034
• Eeles, R. et al (2009). Identification of seven new prostate cancer susceptibility loci through a genome-wide association study Nature Genetics DOI: 10.1038/ng.450
• Al Olama, A. et al (2009). Multiple loci on 8q24 associated with prostate cancer susceptibility Nature Genetics DOI: 10.1038/ng.452
• Pleasance, E. et al (2009). A comprehensive catalogue of somatic mutations from a human cancer genome Nature DOI: 10.1038/nature08658
  
• Pleasance, E. et al (2009). A small-cell lung cancer genome with complex signatures of tobacco exposure Nature DOI: 10.1038/nature08629
  

Sunbeds increase the risk of skin cancer

In Parliament yesterday Julie Morgan, the Labour MP for Cardiff North, introduced a Private Member’s Bill aimed at preventing under-18s using sunbeds.

This is great news and means steps are being taken to answer our call to ensure children and teenagers are protected from the dangers of sunbeds.

What is a Private Member’s Bill?

Every year twenty MPs names are drawn out of a ballot. This gives them the opportunity to put forward a Bill of their choice in the hope of making new laws. This time round, Julie was drawn high up in the ballot and, with our help, is taking forward a sunbeds bill.

This follows on from Sian James’, MP for Cardiff East, hard work in raising the profile of sunbeds in parliament.

What does the Bill include?

The Bill would make it a criminal offence for a sunbed operator to allow anyone under the age of 18 to use a sunbed.

What happens now in Parliament?

Private Member’s Bills can only be debated in Parliament on certain days, meaning that there isn’t usually enough time for them to become law.  This session of Parliament is especially short because of the General Election, which needs to happen before June 2010 (pdf).  Nevertheless, this is an important opportunity to make the case about why action is needed to protect young people from the dangers of sunbeds.

We will continue to work closely with Julie Morgan MP to make sure that there’s as much support in Parliament for the Sunbeds Bill as possible.  Andy Burnham, the Health Secretary has expressed enthusiasm for taking action on sunbeds – but parliamentary time is short.  In Scotland, legislation regulating sunbeds became law on 1^st December 2009.

We very much hope that other MPs in Parliament will support the Bill when it’s first debated early in the New Year.

Henry

SUMO proteins gather at sites of DNA damage

For example, sticking a SUMO protein onto another protein can shuttle it to a different location in the cell, or alter how it works.

And there’s tantalising evidence that SUMO proteins are involved in the repair processes that patch up our DNA during daily wear and tear. Given that damage to DNA can lead to cancer, understanding how SUMO proteins are involved in DNA repair could yield clues in the hunt for new cancer treatments.

Two new papers published today in the journal Nature, from researchers funded by Cancer Research UK and the Breast Cancer Campaign, help to unravel the mystery of SUMOs’ involvement in DNA repair.

SUMO proteins collect around damaged DNA

The first paper under the microscope is from Professor Steve Jackson and his team at the University of Cambridge, who Cancer Research UK have funded for more than 15 years.

Jackson is a world-leading expert in DNA damage research, and has made many significant discoveries in the field. Lately, his team have been searching for proteins that spot DNA damage in the cell and help to recruit molecular ‘repair kits’ to fix it. They’ve been mainly focusing on “double-strand” DNA breaks – the most serious form of damage, where strands of DNA are completely snapped in two.

This type of damage is a big problem…  imagine tearing a book in half – pages start to fray, some fall out, and it’s a nightmare gluing the halves back together.

Similarly, double-strand DNA breaks are really difficult for our cells to repair – and there’s a risk that the wrong ‘ends’ will be stuck together.

Jackson studies these breaks by inflicting them on cells, either with radiation or with a highly targeted laser. And to study the role of SUMO proteins, his researchers have ‘tagged’ them with colourful, glowing markers. This allows the researchers to watch them moving around the cell with powerful microscopes.

Jackson’s team found that after double strand breaks occur, SUMO proteins flood into the sites of the damage after just a few minutes, stay there for a couple of hours, and finally drift away.

These experiments reveal that SUMO proteins appear to have an impressive ability to home in on double-strand breaks in DNA, and help to recruit important repair proteins.  When their work is done, they just detach and move on. The team also discovered that two additional proteins called PIAS 1 and PIAS4 are needed to attach the SUMO proteins to sites of damage – the first time a role has been found for these molecules in DNA repair.

Making the link to BRCA1

The second Nature paper, from Dr Joanna Morris and her team at Kings College London, delves deeper into SUMO proteins’s relationship with one of the biggest players in double-strand break repair – BRCA1.

BRCA1 is a protein made by the well-known BRCA1 ‘cancer predisposition gene’, and may be familiar to regular readers of the blog – for example, in this post about the “BRCA-free baby”.  Inherited faults in BRCA1 cause breast, ovarian and prostate cancer – without this crucial gene, cells cannot repair their DNA properly and become cancerous.

Dr Morris and her team discovered that, somehow, SUMO proteins gets stuck onto BRCA1 protein in response to DNA damage, dragging it into affected sites.  Further experiments  confirmed that PIAS1 and PIAS4 – the two proteins Jackson’s group identified – are responsible for sticking SUMO proteins onto BRCA1 and helping to locate it at sites of DNA damage.

But SUMO doesn’t just help to move BRCA1 to the right place. Crucially, it also helps it do its job once it’s there.

Among its many jobs, Dr Morris’s group found that BRCA1 sticks a small protein called ubiquitin (itself a close relation of SUMO) onto other proteins. This tags them for desctruction and it plays an important part in DNA repair – if the parts of BRCA1 responsible for this ‘sticking’ are faulty, DNA repair is harder and the risk of breast cancer rises.

And BRCA1 can only start attaching ubiquitin if it has SUMO stuck to it. Dr Morris’s key finding was that SUMO, in effect, switches BRCA1 on.

What does it mean?

Just as size isn’t everything in Sumo wrestling, these tiny proteins could have a powerful impact on research into DNA damage and repair.  We’ve previously written about PARP inhibitors – exciting new drugs that were discovered after extensive research into exactly how cells repair their DNA..

It’s safe to say that understanding more about the complicated and interconnected pathways involved in repairing our DNA will lead to further targets to be exploited by cancer drug developers – although this is just the first step along a very long road.

Kat

A 'circus plot' of mutations in the lung cancer genome

It’s been a bumper week for research on cancer. As we report elsewhere, scientists have been delving deep into our cells’ DNA repair mechanisms, and finding out how they tick.

At the opposite end of the spectrum, two more papers published in Nature today look at what happens when DNA repair goes wrong, by mapping DNA damage across the whole genome of two types of cancer – melanoma and lung cancer.

What’s so remarkable – and groundbreaking – about these papers is not that they find new genes involved in cancer. It’s that the technique the scientists used to identify genetic damage allows them to identify what caused these mutations – and also build up a picture of how the cancers developed, on a molecular level.

This is a veritable treasure-trove of scientific information – the sort that has the potential to unlock some of cancer’s deepest secrets.

We’ve covered the ins and outs of these two papers on our News feed – but briefly, researchers at The Wellcome Trust Sanger Institute in Cambridge sequenced the entire DNA genome from the cells of two cancer patients – one with lung cancer, one with melanoma, and also from healthy cells from the same individuals. This allowed them to compare the two and pinpoint mutations scattered around the cancers’ DNA.

The stark finding was that the melanoma cell contained more than 33,000 mutations; the lung cancer one about 23,000.

They also saw evidence of how the cells had desperately tried to repair their damaged DNA in the face of a carcinogenic onslaught.

A key implication of their findings is that there was no stand-out “master switch” for cancer – instead, it confirms the idea that cancer occurs after a number of key cellular processes become damaged over time.

In fact, the beauty of the data is that the researchers should now be able to reconstruct the events that led to cancer in the first place – a sort of molecular archaeology dig.

Context, not content

As we alluded to earlier, this wasn’t a typical ‘gene hunting’ exercise – it was much more than that. By analysing the ‘context’ of each mutation – i.e. the DNA sequences that appear either side of it – researchers were able to glean clues as to what caused each one.

As you’d imagine, the cancer genomes both bore the tell-tale signs of their causes – tobacco smoke in the case of lung cancer, and UV radiation in the case of skin cancer.

As lead researcher Professor Peter Campbell said of the lung cancer finding:

“The profile of mutations we observed is exactly that expected from tobacco, suggesting that the majority of the 23,000 we found are caused by the cocktail of chemicals found in cigarettes. On the basis of average estimates, we can say that one mutation is fixed in the genome for every 15 cigarettes smoked”

Why skin and lung cancers?

The researchers chose skin and lung cancers because they’re two forms of the disease that have well-defined causes. This allowed researchers to test the theory that they’d be able to see ‘fingerprints’ of tobacco smoke and UV radiation all over the cancer genomes.

But other types of cancer don’t have such clear cut causes. The great hope now is that scientists can use this technique to identify the chains of events that lead to other cancers. Indeed, partial progress has already been made in this arena – in September a group of researchers, including Cancer Research UK’s Professor Carlos Caldas, published data on the breast cancer genome, and another US group has sequenced the genome of a patient with acute leukaemia.

Next generation sequencing

These studies were only possible thanks to the extraordinary advances in ‘massively parallel’ gene-sequencing technology over the last few years. And as this technology continues to progress, we’ll see more studies like these, generating reams of new information for scientists to pore over.

The decade began with the publication of the first draft of the human genome in 2000. It’s now ending with a flurry of papers that build on the Human Genome Project, and yield new and exciting insights into how cancer develops – insights that are sure to turn, eventually, into benefits for people affected by the disease.

Henry

Cancer Research UK's Chief Clinician Professor Peter Johnson and lead trial researcher Dr Penelope Brock at the press conference announcing the trial

Cancer in children is not common. And although this is something to be thankful for, it can make things a little more challenging for researchers. This is simply because if fewer people have a particular type of cancer then there are fewer people to take part in clinical trials.

To help overcome this hurdle, Cancer Research UK funds 20 childhood cancer clinical trial centres across Great Britain, linked together within the Children’s Cancer and Leukaemia Group (CCLG).  Our scientists also collaborate with research groups around the world to run international trials into childhood cancers.

And today, we announced the opening of an international clinical trial into neuroblastoma – a rare type of childhood cancer.

The trial is a perfect example of how research can bring pioneering new treatments to children with cancer in the UK – and is based on some really exciting scientific discoveries…

A new way to tackle neuroblastoma

Around 100 children are diagnosed with neuroblastoma in the UK each year – most of whom are under the age of five. The cancer grows from nerve cells ‘left over’ from the development of the nervous system, and often starts in the abdomen.

About half of all children with the disease have a more aggressive form called high-risk neuroblastoma. It’s these children who will be taking part in the new trial, which is testing a type of immunotherapy – a catch-all term used to describe treatments that use the power and precision of the body’s own immune system to fight disease.

In the new trial, patients will be given a type of molecule called a monoclonal antibody. These are proteins produced in the lab that can stick to particular molecules on the surface of cells – in this case, molecules called GD2 antigens that are found on the surface of neuroblastoma cells.

The antibodies are injected directly into the patient’s bloodstream, where they travel around the body and eventually encounter the tumour, and stick to the GD2 antigens on the cancer cells.

Once the cancer cells are ‘labelled’ in this way, the body’s immune system can recognise them – and destroy them.

A similar technique to the one being tested in the new trial has already shown exciting results in a US study, and until now the treatment has only been available in America.

As in most trials, the US study compared the outcome for two groups of patients – one receiving the new treatment and one the standard treatment. But the new antibody treatment was so promising that the trial was modified so that all children participating ended up receiving it.

The treatment is designed to be used after a child has been treated with a combination of surgery, chemotherapy and radiotherapy. These standard treatments eliminate most of the cancer cells, and then the highly targeted antibody should – in theory – encourage the child’s immune system to mop up any that remain.

The new trial will split participants into two groups. One will receive the antibody alone, and the other the antibody and another molecule called a cytokine.

Cytokines are molecules produced by the cells of the immune system. They act as signals that can attract more immune cells to a particular area. The theory is that the extra cytokine will encourage the immune system to mount a more powerful attack against the neuroblastoma cells.

All participants in the modified US trial received the antibody with one of two different cytokines, so this new trial is the first time treatment with the antibody alone has been tested. The new trial aims to discover which approach gives the best outcome for patients.

The promise of immunotherapy

Immunotherapy is an area that’s been under intense research for over a decade, and has shown promise in treating other types of cancer. The breast cancer drug Herceptin is another example of a monoclonal antibody-based treatment.

But as Cancer Research UK’s chief clinician Professor Peter Johnson explained, ‘this is the first time an antibody has been taken into treatment for childhood cancer.’

And it spells good news for children with aggressive neuroblastoma. At our press conference, Great Ormond Street Hospital’s Dr Penelope Brock, the lead researcher on the trial, said the rapid launch of this trial in the UK was really fantastic news for patients. ‘Early results from the US trial found that children who received the immunotherapy treatment had less chance of the disease coming back two years later, compared with patients who did not receive the antibody.’

The new trial means that children in the UK now have access to what Dr Brock says is ‘possibly the biggest breakthrough in neuroblastoma for a very long time.’ However, she also sounded a note of caution, saying that longer term outcomes are still not known and so further international trials will be necessary.

For uncommon cancers like neuroblastoma, international trials are vital for to ensure that enough participants are included to give accurate results. This trial aims to recruit 2000 patients from across Europe, including about 160 children with high-risk neuroblastoma from the UK. The team are hoping that nearly all eligible children in the UK will take part in the trial and receive the new treatment – the first two participants are starting their treatment this week.

Committed to childhood cancer research

Cancer Research UK is the largest funder of research into children’s cancers in the UK – we spent over £9 million last year on research in this area. For this latest trial, we are paying not only the running costs but also the cost of manufacturing the new treatment. This is because the drug is so cutting-edge that no pharmaceutical companies (that would usually supply drugs for a clinical trial) are yet involved.

We have also funded many of the world’s most successful trials of children’s cancer treatments, and more than three quarters of children with cancer in the UK now survive. Back in the 1960s, only a quarter of children survived – a testament to how investment in scientific research can ultimately improve treatment and care.

Nell Barrie, Science Information Officer

Professor Jane Wardle and her team

It’s been a big week for cancer news, as we blogged about yesterday.

The Government’s report on progress against the Cancer Reform Strategy showed how much cancer survival varies across the country, and another story presented figures from Professor Mike Richards, National Cancer Director, estimating that earlier diagnosis could save between 5,000 and 10,000 lives a year.

The National Awareness and Early Diagnosis Initiative (NAEDI) was set up to tackle these problems. The initiative supports local projects and new research, together with lots of other activities that aim to promote early cancer diagnosis. But until now, the evidence that backs up the initiative was scattered around.

So that’s why the latest supplement of the British Journal of Cancer – published this week – is really important. It sets out, in one place, key evidence and new research that underpins the initiative.

We’ve already heard about Professor Richards’ paper and his estimate of the ‘size of the prize’ for early diagnosis. Here we take a look at two other papers from the supplement – one looking at bowel screening, and another looking at awareness of cancer symptoms.

Bowel cancer screening – who’s taking up the invitation?

The bowel screening programme is the latest to be introduced in the UK. Now that its roll-out is almost complete, a team of researchers at University College London looked at how many people in London returned their bowel screening kits, and more importantly, what made people more or less likely to return them.

They found that the most affluent people were 50 per cent more likely to take part in the bowel screening programme – only 1 in 3 people in the most deprived areas returned their kits, but 1 in 2 people in the most affluent areas did.

Information from the pilot areas (where bowel screening was first introduced) gave an early warning of differences in uptake by socio-economic status. But we still don’t know why people living in more deprived areas are less likely to participate. Professor Jane Wardle, whose team was behind the latest study, called for more research to understand the barriers to participating across all social groups, pointing out:

There’s a real danger that bowel cancer could increasingly become a disease of lower social class if these figures hold true across the UK.

We know that more than 90 per cent of bowel cancer patients survive if the disease is caught at the earliest stage, compared with around six per cent for cases detected at the latest stage.

Screening helps to spot early signs of bowel cancer, as well as pre-cancerous growths that don’t cause any symptoms, so it’s important that everyone who receives a testing kit takes part.

You can find out more about bowel screening on our Spot Cancer Early pages.

How much do we know about cancer?

Diagnosing cancer early becomes much more likely if people with early symptoms of cancer visit their doctor – and for that to happen, they need to be aware that the symptoms they are experiencing could be linked to the disease. So how ‘aware’ is the British public? What can affect ‘awareness’? And how do you measure and evaluate it?

To try to find out more about cancer awareness, Professor Jane Wardle’s group have developed a face-to-face questionnaire – the Cancer Awareness Measure, or CAM – to assess people’s awareness of cancer causes and symptoms, and to unpick their attitudes and barriers to seeing a doctor.

The CAM was put to test in September and October 2008, as part of the Office of National Statistics Opinions Survey. Researchers carried out face-to-face interviews with 2216 people in their homes around the UK, and the results of these surveys are also published in today’s supplement.

The findings are stark. Aside from ‘lump’, which nearly 70 per cent of people identified as a ‘warning sign’ for cancer, awareness of other symptoms -  such as bleeding, weight loss, pain, coughing  or difficulty swallowing – was remarkably low. Generally only about 20 to 30 per cent of people identified these without any prompting.

Women were a bit more aware than men, suggesting that the commonly held conception of men as less concerned about their health – or perhaps in denial – still holds true.

Older people seemed much more aware of cancer symptoms, and socioeconomic status seemed to matter too.  People from poorer backgrounds were able to recall fewer signs of cancer than the well-off.

Respondents were also asked about what might deter them from seeing a GP, and their replies were divided up into ‘emotional’ barriers (scared of what the doctor might find, embarrassed, unconfident and so on), ‘practical’ barriers (such as being too busy or having  other things to worry about), and ’service’ barriers (such as difficulty getting an appointment).

And here, too, there were clear differences between people of different socioeconomic status – people of lower income were far more concerned about emotional barriers, whereas the better-off were more concerned about practical barriers.

Where next?

Understanding where inequalities exist, as well as what might be driving them, is the first step in starting to reduce them.

With the publication of all this evidence, the work done through NAEDI can go from strength to strength. The more we build the evidence base, the better we’ll know what works and what doesn’t. This means we’ll be more effective, and can do more to reduce inequalities.

And if we can go on like this, we’ll be going even further towards meeting Professor Mike Richards’ challenge to save many more lives through earlier diagnosis.

Jess and Henry

New government figures show alarming variations in regional cancer survival

This week has seen two high profile stories about cancer survival hit the headlines.

Both have, in their own way, highlighted what we and others have been saying for some time – that late diagnosis of cancer is a big, but ultimately solvable, problem.

The first story appeared in the Guardian, the Mail and the Telegraph on Monday, and claimed that late diagnosis of cancer was  ‘killing 10,000 every year’.

This story came from an article written by Professor Mike Richards, the government’s Cancer Director, which is being published later this week in Cancer Research UK’s journal, the British Journal of Cancer.

Professor Richards looked at differences in survival rates between England and the rest of Europe for lung, bowel and breast cancer – the three most common types in this country.

Lots of things could explain these variations and Richards considered the impact of each one in turn, including differences in:

• delays before the cancers are diagnosed;
• screening services;
• access to treatments, and the quality of those treatments;
• the basic biology of these three cancers;
• other diseases or conditions that affect people with these cancers.

Based on this analysis, he estimated the ‘size of the prize’ at around 5,000 to 10,000 lives a year in England, which could be saved through a combination of earlier diagnosis and better access to surgical interventions.

The second story hit the headlines yesterday, and struck a similar chord. As reported in almost all the mainstream media, the Department of Health has published its second report on progress on its Cancer Reform Strategy.

The report contains a lot of good news – for example, on bowel screening, HPV vaccination, and the training of new surgeons and specialist teams. But on regional variations in cancer survival – the so-called ‘postcode lottery’ – it makes sobering reading.

But before we look at these problems, let’s just pause to consider the report’s significance.

Landmark figures

Thanks to this report, for the first time ever, we have a clear picture of the discrepancies in cancer survival around England. Although we might not like what it says, this analysis is absolutely critical in helping improve cancer services, as it allows the NHS to target resources and advice to where it’s most needed – and also to identify the areas that are performing best, so that they can share their experience with others.

Indeed, the report’s very existence shows that the government is taking seriously the challenge of improving cancer services – and the lives of cancer patients.

It’s also worth pointing out that the survival analysis is a snapshot, and says nothing about how these figures have changed over the last few years. But we know from other studies that things are – slowly – improving.

One-year survival

One thing that’s especially welcome is the new focus on using one-year relative survival rates to measure and compare the effectiveness of cancer care.

“One-year relative survival” is calculated by comparing the percentage of cancer patients who are still alive one year after their diagnosis with the expected survival rate of a similar group of people in the general population.

This measure is used as an indicator of how early diagnosis and treatment affect cancer outcomes – and these rates are very sensitive to how advanced tumours are when they are diagnosed.

The report, which can be downloaded from the Department of Health website, highlights a number of uncomfortable truths:

• For bowel cancer, one year survival reached 80 per cent in Telford and Wrekin while the worst rates were seen in Waltham Forest, and Hastings and Rother (58 per cent).
• In lung cancer, Kensington & Chelsea had the best survival rate of 44 per cent and the worst was Herefordshire with 15 per cent.
• Breast cancer survival was 99 per cent in Torbay, and the worst was Tower Hamlets with one-year survival at 89 per cent.

Action needed

So let’s also be absolutely clear. The fact that cancer survival is so variable across so much of England is unacceptable; especially given what we know about how early diagnosis can improve survival. Whether you survive cancer should not depend on where you are diagnosed and treated.

The government has made many promises about how it intends to improve peoples’ access to diagnostics, and to improve peoples’ awareness of the signs and symptoms of cancer. The launch of the National Awareness and Early Diagnosis Initiative (NAEDI)  and its local counterpart (LAEDI) are significant steps in the right direction.

But ultimately we need government to make good its promises on diagnosing cancer early.

In addition, we’d also like to see:

• Primary care trusts, who can allocate funds within their budgets as they see fit, ensuring that they properly prioritise early cancer detection
• Well-coordinated, funded and targeted campaigns – nationally and locally – aimed at improving people’s awareness of cancer symptoms
• Renewed focus on ensuring all GPs and other front-line health professionals are fully up-to-speed with the latest evidence on cancer symptoms and diagnosis
• Proper flow of information from best-performing PCTs to those that are struggling

The 2007 Cancer Reform Strategy rightly put proper emphasis on early diagnosis. Despite today’s figures, things are improving, and this second report is an excellent and solid benchmark against which future progress can be measured.

Be aware

But it’s not all about government policy and healthcare management. A key factor in all of this is that people often don’t seek help when they experience the signs and symptoms of cancer.

So have a read of our Spot Cancer Early web pages, watch our symptom awareness videos, and remember to see your GP if you notice anything unusual – it probably won’t turn out to be cancer, but it just might save your life.

Henry

Click on the image to listen to the latest podcast

After three years and thirty five episodes, we’ve decided to give the Cancer Research UK podcast a revamp.

As of this month, our podcasts will be shorter and snappier.  We’ll be focusing on the latest news, as well as bringing you in-depth features and discussion of the biggest stories. And there’s even a new theme tune.

In the December podcast we take a look at the alarming numbers of children using sunbeds, as well as checking out the headlines.

You can listen to the podcast through this player:

Or click here to download the podcast as an mp3.

Alternatively, go to the podcast homepage, where you can hear the show directly through our own Flash player. And there’s also a full transcript of the podcast here.

We hope you enjoy it – please do let us know what you think of the new style podcast in the comments below.

Kat

NICE has decided not to recommend sorafenib (Nexavar)

NICE’s decision today not to recommend sorafenib – also known as Nexavar – to the NHS for the treatment of advanced liver cancer, is deeply disappointing for a number of reasons – namely the drug’s cost; the fact that it works; the questions this raises over NICE’s processes; and the effect this has on public perceptions of cancer care.

But before we examine these, we need to clarify the nature of NICE’s latest guidance. Several media reports have suggested that these are preliminary and thus open to consultation – but they’re not.

This is a ‘final decision’ – i.e there will be no further consultation. However, the decision is open to appeal for the next fifteen days, before the final guidance is formally published in a month or so. And NICE have told us that they’ll leave their decision open to review as new evidence emerges.

But with that clarification out the way, let’s return to the decision itself, and why we and others are so disappointed.

Cost

Firstly, this treatment is expensive. Although the drug’s manufacturer (Bayer) have offered the NHS a ‘buy three get one free’ deal, they are unable (or unwilling) to lower the drug’s price to a level that the NICE appraisal committee feels able to accept.

Bayer’s efforts to lower the price to about £3,000 per month still do not bring it within NICE’s limits of what it regards as an acceptable use of taxpayers’ money.

NICE have talked about the other treatments that the NHS could buy for its money. And, to an extent, they have a point.

Effectiveness

But as our chief clinician Professor Peter Johnson pointed out on BBC’s Today programme this morning, sorafenib works.

Most patients with advanced liver cancer can’t be operated on – and surgery is the only treatment that can cure the disease. For people for whom surgery is not a suitable option, there are no alternative treatments – and average survival is about eight months as a result.

Clinical studies have shown that sorafenib can extend people’s lives for an extra four months on average.

And as part of the appraisal process, NICE heard from doctors who have experience of using this drug and who have seen in practice the benefit that it can give.

Transparency

This leads on to a question once again about how NICE makes its decisions.

Is it right that NICE is making recommendations that are at odds with clinical experts? And do we know what sort of priority NICE is giving to these doctor’s opinions, and how they weigh this up against the cost and other evidence available?

To add to this, earlier this year, NICE announced that it was bringing a new series of guidelines to deal with drugs used to extend life in the terminally ill, where there are few other alternatives, which we welcomed at the time.

But although these guidelines were applied in this case, they don’t seem to have solved the problem. It may be that these guidelines aren’t being applied consistently as yet – it’s difficult for us to tell from the information that NICE has given us.

Wider issues

Finally, high-profile decisions not to recommend life-saving extending drugs like this have a corrosive effect upon people’s perception of cancer treatment in this country. As an organisation, NICE makes extremely tricky and often controversial decisions – but very few of its favourable decisions receive as much media attention as its negative ones.

It’s unfortunate that, despite the fact that there’s been so much improvement in cancer care over the last decade, stories over denial of access to expensive cancer drugs continue to dominate the headlines, and give people a poor impression of the quality of cancer care in the UK.

Will Cancer Research UK appeal against the decision?

As we mentioned above, NICE’s decision is open to appeal. But we won’t be appealing.  This is because the appeals process is to allow stakeholders in the consultation process to submit new clinical or economic evidence to NICE’s committee.

Sadly, even though we were stakeholders in the consultation, we have no new evidence to submit – nor can we in any way influence the cost of the drug. We will absolutely support any such appeal where possible, but in this instance, frustratingly, we’re just going to have to hope that a deal can be struck.

Henry

Our information nurses receive thousands of calls every year

A diagnosis of cancer can be a confusing time, where a lot of new information can arrive very quickly.

Patients can, of course, discuss things with their doctor whilst they’re in hospital or when they visit their GPs. But it can also be enormously reassuring to speak to someone else at a later date, under your own steam, once you’ve had time to reflect. 

And a hospital or surgery isn’t always the best place to look up or take in information about cancer. 

You only have to look at the demand for Cancer Research UK’s patient information services to see that there’s a real need for them.  Currently we run a variety of resources – the recently relaunched CancerHelp UK website; our forum Cancer Chat; an e-news letter Cancer Spotlight; and our Cancer Information Nurse service.

Our nurses are there to answer individual enquiries from the public about any aspect of cancer and its treatment, through our freephone telephone helpline and our email service. 

Although demand to our service is high (we respond to around 10,000 phone and email enquiries every year), we’re always very keen to get hard evidence that we‘re giving people what they want, and that they’re satisfied with what they’re getting from us – so each year we carry out a user-satisfaction survey.

Survey results

On the whole we get a very positive response, recording high levels of satisfaction – typically, 97 per cent of the respondents said they would use us again and 97 per cent of telephone use – and 99 per cent of the email users – stated that they would recommend us to others. And this year, one key question we asked was whether contacting us was worthwhile.

Reassuringly, we received an overwhelmingly favourable response to this question – 98 per cent of telephone and 97 per cent of email users said they felt it was worthwhile.

Given the range of services we now provide (the most recent addition being our Cancer Chat forum) we were also interested in seeing if people were using more than one of them. 

Gratifyingly, we found that there was indeed a proportion of people who not only contact the nurses but also seemed to be using CancerHelp UK and Cancer Chat, as well as using our email and phone services. This is just the first hint of an emerging pattern, and we’ll be following this up in next year’s survey.

Real need

When doing background work before the survey, we found that there wasn’t a great deal of published research about how people use cancer information services.  However, from the literature that is out there, common themes did emerge from around the world.

One of the key conclusions from this research – which we also found in our survey- is that there’s a real need for these types of service. Patients and their relatives and friends need to access high-quality information at times other than when they are in hospital.

The results of our survey and the literature search are published in the November issue of the nursing journal Cancer Nursing Practice.  So hopefully more nurses looking after cancer patients will see that sign-posting their patients to services like ours – services that they can use when they’re not in hospital – is really worthwhile.

Martin Ledwick

Martin manages Cancer Research UK’s Information Nurse Team

The UK government should regulate sunbed use

Today we published research in the British Medical Journal that looked at sunbed use amongst teenagers in England. The research has been widely covered in the media – and our spokespeople have had a busy morning being interviewed for local and national television and radio.

Our findings are stark. Young people across England say they’re using sunbeds in large numbers – on average, 6 in every hundred 11-17 year olds have used sunbeds.

This rate of sunbed use would lead to more than an estimated quarter of a million 11-17 year olds being put at increased risk of developing malignant melanoma

And in some areas of the country this figure’s even higher. In Liverpool, for example, we found that half of girls aged between 15 and 17 say they use sunbeds regularly.

This is deeply worrying. Skin cancer rates have been climbing rapidly for the last few decades, and there’s sound scientific evidence that UV radiation from sunbeds can cause the disease.

Earlier this year, IARC – the international body that analyses potential causes of cancer – placed sunbeds in its highest category, Group 1. This means that there is convincing evidence that sunbeds can cause cancer in humans.

Indeed, an IARC overview of studies on sunbeds and cancer showed that people who first use sunbeds before the age of 35 have an estimated 75 per cent higher risk of melanoma – the most serious type of skin cancer. 

Why do people use sunbeds?

It’s revealing to look at why people say they use sunbeds. We’ve conducted focus groups on this subject, and people cited four key reasons for using sunbeds:

• Access to sunbed salons is easy
• Using a sunbed is cheap
• It’s something to do together with friends and older siblings
• There’s still a desire, and peer pressure to have a tan – i.e. to look more attractive

In these focus groups, people often said that they knew of the health risks, but rationalised their sunbed use by arguing that “their friends used sunbeds more than they did”.

We need legislation – quickly

Taking all this evidence together, Scotland is introducing legislation on sunbeds. But the UK government has been slow to introduce similar laws covering England and Wales (although the Welsh Assembly has recently published a report outlining the need for such legislation)

And in June this year, the government’s Committee on Medical Aspects of Radiation in the Environment (COMARE) also called for legislation – as we reported here.

Clearly, government needs to act. Voluntary regulation hasn’t worked. We want to see legislation which will:

• Place a ban on under 18s using sunbeds
• Ban unstaffed and coin-operated salons
• Require all salons to have trained staff to supervise people using them
• Require salons to provide clear, accurate health information to their users so that adults can be free to choose but will do so knowing the risks involved

This last point is important. Responsible adults have a right to chose whether they use a sunbed or not.  But it’s important  that they’re given all the information about the health risks.

But as well as informing adults, Cancer Research UK believes protecting children is a priority. We, and others, campaigned hard to protect children from the dangers of tobacco marketing with our Out of Sight, Out of Mind campaign. And this week, the government passed laws banning displays of tobacco at point of sale, and banning cigarette machines.

Now it’s time they took similar steps to protect our children from unregulated and irresponsibly marketed tanning salons.

Henry

The Health Bill has become the Health Act

After almost a year and a half of campaigning, measures to help protect children from tobacco marketing were yesterday enshrined into law.

The Health Bill 2009, which bans the display of tobacco at the point of sale and prohibits tobacco vending machines received Royal Assent yesterday evening and became the Health Act 2009.

Since August last year, Cancer Research UK’s Out of Sight, Out of Mind Campaign has been calling for these measures as part of a comprehensive tobacco control strategy.

When the government announced that it would introduce a ban on tobacco displays and age-restrict vending machines in December last year, Cancer Research UK, with its partners in the Smokefree Action coalition worked hard to persuade Parliamentarians of the need for these measures and to go further and remove tobacco vending machines altogether.

After a lot of meetings, letters and over 8,000 emails from our supporters, our hard work finally paid off when MPs voted to ban cigarette vending machines completely and to end the display of tobacco at the point of sale. The Bill then passed between the House of Lords and Commons to be finalised before being passed into law yesterday.

Every year around 340,000 under-16s try cigarettes for the first time. These measures will help to significantly reduce the number of young people taking up smoking – a lethal addiction that kills half of all long term users.

After the Bill received Royal Assent - the final step for the Bill to become a law – Harpal Kumar, our chief executive, said:

“This is a great result. A complete ban on vending machines will reduce children’s access to cigarettes and putting tobacco out of sight in shops will also help to protect young people from tobacco marketing. It’s vital we do all we can to stop young people succumbing to an addiction that kills half of all long term smokers and this legislation is an important step towards that goal.

“Parliament should rightly feel proud of putting the health of our children ahead of the profit of the tobacco industry. Our supporters deserve congratulations also. Their involvement helped communicate to their MP just how strong the public backing was for these measures.”

Your support has been vital in helping us achieve this fantastic result; so on behalf of everyone at Cancer Research UK, thank you!

Helen Haggart, Tobacco Control Officer