Cancer genes, breast cancer tests and children smoking

Cancer Research UK
We discuss a new study shedding light on cancer genes, genetic tests for breast cancer patients and worrying numbers of kids taking up smoking.

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This month, a landmark cancer study sheds light on tumour genes; more breast cancer patients should have genetic tests; worrying numbers of kids taking up smoking; model agencies sign up to no-sunbed policy; drug combo destroys pancreatic cancer; and ignorance and fear are behind thousands of avoidable cancer deaths.

Transcript

Welcome to the Cancer Research UK podcast. I’m Paul Thorne.

Taking a sample from just one part of a tumour may not give a full picture of its ‘genetic landscape’, according to a landmark study led by scientists at Cancer Research UK’s London Research Institute.

The findings help explain why using single tumour samples, known as biopsies,  to tailor cancer treatment has not been as successful as expected.

The researchers analysed genetic variation between different samples from a single kidney tumour, as well as secondary cancers in the same patient. They found that around two thirds of gene faults were not shared between the different samples.

As well as highlighting the challenges and complexity of tailoring treatment to the genetic makeup of an individual’s cancer, the research also shows scientists how to move forward in solving some of these problems.

Lead author Professor Charles Swanton explains what makes these findings so compelling.

“So the main findings from this study illustrate to us the complexities of what is now known as personalised cancer medicine, where a clinician tends to rely on treatment decisions based on a single biopsy from one tumour site.

And what we found is that no single biopsy was identical to another biopsy, and that each biopsy was different quite major ways in fact - so much so that approximately two-thirds of the mutations present in a single biopsy were not shared across all biopsies from the same tumour.

I think if we begin to think of tumours as ‘trunks’ and ‘branches’ what I think we need to start doing is working out what are the distinct driver events that are driving the tumour biology in the trunks of the tumour that are present at all sites of the disease.

I think those are going to be much more robust therapeutic targets for cancer therapies than perhaps targeting individual mutations in the ‘branches’ that are heterogeneous or different from one region to the next.”

Leading breast cancer experts are calling for hundreds more women under 50 who are diagnosed with triple-negative breast cancer to be offered testing for faults in the BRCA1 gene.

The researchers – funded by Cancer Research UK and led by scientists at The Institute of Cancer Research – looked at more than 300 women with triple-negative breast cancer and found BRCA1 gene faults in nearly one in five women diagnosed under the age of 50.

Lead author Professor Nazneen Rahman, from the Institute for Cancer Research, tells us why it’s important to identify these women.

“It’s very important to know whether a woman with breast cancer has developed that breast cancer due to a BRCA1 gene fault because it has considerable implications both for her own personal management and also potentially for her family.

For the woman herself, if her breast cancer is due to a BRCA1 fault, she’s at increased risk of having further trouble from breast cancer, and also of having ovarian cancer. So that would have an impact potentially on what surgery she might choose to have – more radical compared to conservative surgery. It also has an impact on which chemotherapies are likely to be most beneficial for her.

Many women with breast cancer due to a BRCA1 gene fault do go on to consider different options with respect to reducing their risk of ovarian cancer in the future, and of course we can have this information before they develop that cancer, which gives us many more opportunities of potentially reducing the risk or preventing that occurring.

The other area that’s very important is with respect to other family members. We can then potentially work out who in the family doesn’t carry the mutation, and that means they’re not at increased risk – so obviously that’s very reassuring. But there may be some relatives who do carry the mutation, but then again we’d known that information ahead of time while they’re still well, and so they have options for screening or preventative measures to help ensure that they stay well and hopefully remain cancer-free.”

Every year, around 157,000 children aged 11-15 start smoking – enough to fill more than 5,000 classrooms.

These shocking figures, revealed in a new analysis by Cancer Research UK, highlight the ongoing scale of the tobacco problem.

Almost one million children in the UK have tried smoking at least once and eight out of ten adult smokers start before they turn 19. The figures emphasise why it’s vital to prevent young people from being tempted to try smoking in the first place.

Robin Hewings, tobacco control manager at Cancer Research UK, tells us why these figures need urgent action.

“These figures show that far too many young people are taking up smoking each year. We’ve made a lot of progress, but it’s still 157,000 too many people starting smoking. We know that the way that cigarettes are sold at the moment, in attractive, glamorous packs, makes them seem much more attractive to young people.

We think that should change – they should come in standardised packs with public health warnings, so cigarettes become less attractive. It won’t stop everyone from smoking but it will give millions of children one less reason to start.”

Directors of leading model agencies including Storm, Premier, Elite and Next have all committed to a No Sunbed policy in conjunction with Cancer Research UK’s R UV Ugly campaign, aiming to raise awareness of the dangers of using sunbeds.

Under this new policy, model agencies will take a zero tolerance approach to sunbed use for all models on their books or wishing to join.

Jessica Harris, health information manager at Cancer Research UK, tells us why this groundbreaking act of unity marks an important step in highlighting the risks of sunbeds.

“It’s great that model agencies have signed up to the no-sunbeds policy. We know how much people aspire to look like models, so it’s great that they’ve shown us that sunbeds just aren’t really all that fashionable. Using a sunbed ages your skin, makes it look old, wrinkled and leathery before its time, and also increases the risk of developing melanoma, which is the most serious form of skin cancer.”

Cancer Research UK scientists have revealed how combining two different drugs amplifies the destruction of pancreatic cancer cells.

The team, based at our Cambridge Research Institute, showed that combining an established chemotherapy drug called gemcitabine with a new experimental drug sets off a chain of events that ultimately kills cancer cells – multiplying the effect of each drug on its own.

The drug combination is now being tested in a clinical trial managed by Cancer Research UK’s Drug Development Office in partnership with Cambridge University Hospitals Foundation Trust.

Josephine Querido, science information manager at Cancer Research UK, tells us why this new discovery could have a big impact.

“Pancreatic cancer is really hard to treat - around 8,000 people get it every year and the survival rate is really low, so we urgently need new drugs to treat the disease. We’re prioritising research into pancreatic cancer and hope to save more lives in the future.”

Lack of awareness of the warning signs of cancer could be leading to thousands of avoidable deaths, according to a Cancer Research UK report published earlier this month.

The report, called Delay Kills, forms part of a new partnership between Cancer Research UK and Tesco to tackle one of the biggest causes of avoidable cancer deaths in the UK – late diagnosis.

When asked to list the possible warning signs of cancer, more than three quarters of people failed to mention pain, persistent coughing, or problems with the bowels or bladder – all of which can be possible symptoms.

Even when potentially serious symptoms were recognised, the survey found that nearly 40 per cent of people said they might delay getting symptoms checked out because they were worried what the doctor might find. And more than 25 per cent said they might delay because they feared wasting the doctor’s time.

Our reporter Laura Dibb spoke to Nell Barrie, senior science information officer at Cancer Research UK, about the problem of late diagnosis.

Nell: We know that for most types of cancer, if you diagnose the disease early, it’s much more likely to be treated successfully, and often the treatments can be simpler at that stage as well. So we know it’s really crucial that people go to their doctor if they notice anything that unusual and make sure they get it checked out, because if the disease gets diagnosed at that early stage, treatment’s much more likely to be successful and you’re much more likely to be cured.

One thing that’s worrying is that we know that a lot of people in the UK don’t go to their doctor at that early stage, and there’s a lot of reasons for this. They might be afraid to hear what the doctor has to say, they might be concerned about wasting the doctor’s time, or they may just think that the symptom they’ve got is nothing to worry about. So this type of work, looking at early diagnosis and raising awareness is really important, to make sure that we can diagnose more people early, and help to increase survival rates too.

Laura: We’re still up against the problem of cancer being almost a taboo subject, and people fearing the worst – that they’ve got cancer. Is that still a real problem in the UK?

Nell: Yes, we know that it is. We actually did a survey recently and that discovered that cancer, for many people, is still their number one fear, so many people are worried about the disease. We think that a lot of this is to do with attitudes that cancer is a death sentence – if you get diagnosed with cancer there’s no point in going to the GP, there’s nothing the doctors can do. And this is just not true these days.

We have many successful treatments for cancer, and we know that more people are surviving the disease than ever before in the UK. So we know that people who do go to their GP early are much more likely to be treated successfully, and there are many ways that we can tackle the disease. So it’s not something that people should be afraid of – they shouldn’t be worried about going to the doctor to get their symptoms checked out.

Laura: What does early diagnosis actually mean for the stage of the disease and when it’s diagnosed?

Nell: For most cancers, what will actually kill a patient is when the cancer spreads around the body, and we know that most people who die from cancer, that is what has caused it. It’s the cancer spreading away from the site where it started and causing problems elsewhere. If you can diagnose the disease early, before a tumour’s grown too large, before it’s spread, it can be treated much more easily and it’s much more likely to be cured.  

For example, surgery can remove the whole tumour and you may not need any further treatment after that. So, basically, if you go to the GP at that early stage what we would hope is that more cancers would be diagnosed before they’ve spread, it would be much easier to treat them, and survival rates will hopefully go up.

Laura: This month we’ve heard that Tesco are pledging to raise £10 million over three years for Cancer Research UK. Can you give me some examples of the sort of projects that will be funding?

Nell: The support from Tesco is going to help us fund 32 different early diagnosis research projects that are going on all over the UK. We’re looking at many different types of cancer, from things like skin cancer – we’ve got a project that’s going to help people recognise the types of symptoms they should be looking for by showing images on the internet that people can match up against any symptoms they might have – all the way through to looking at things like screening programmes.

So we’re trying to find better ways to screen for different types of cancer such as lung cancer and ovarian cancer, and trying to improve the current screening programmes we have, because we know that can really help diagnose cancer early and ensure that more people survive.

Laura: Overall, what impact do you think earlier diagnosis will have on cancer survival in the UK?

Nell: We know that the UK does lag behind other European countries in terms of how many people survive cancer. And we think that one of the main reasons for that is that people aren’t being diagnosed at that early stage. We know that some other countries are better at encouraging early diagnosis than we have been in the UK. So we know that all of this kind of work will encourage people to go to their GPs early, and overall this will lead to more people surviving cancer because they will be diagnosed at an earlier stage when it’s easier to treat.

Laura: So people shouldn’t worry about bothering their GP?

Nell: Absolutely not. A lot of people, we do hear them say “I don’t want to bother the GP, I’m worried about wasting their time”. It’s never a waste of their time – you just need to go along, talk about the symptom you’ve got and they’ll check it out for you, and nearly every time you’ll be reassured. But if it is anything serious you can get it checked out sooner rather than later, which is the ideal scenario in terms of cancer.

Laura: And finally, what are your top tips for people being aware of cancer?

Nell: All of this type of awareness-raising and campaigns like this, we’re not expecting people to memorise every single symptom that we talk about. The really key thing that everyone can do just to be aware of your body – know what’s normal for you, and if anything changes, if anything unusual has happened, if you’re having some strange symptoms you haven’t had before, then that’s the time to go to the GP and get them checked out.

And as I’ve said, it’s unlikely to cancer or anything serious and your GP will be able to reassure. But if it there is any concern then they’ll be able to send you for further tests to find out what it could be, and make sure you get any treatments you need as soon as possible.  

Kay Bailey, who is 48 and works as a customer assistant for Tesco in Broad stairs, Kent, also spoke to us about her experience of being diagnosed with Hodgkin’s lymphoma after finding a lump in her neck, which she first thought might be glandular fever.

“I remember waking up and feeling almost sort of fluey type of aching and I really had to spend the rest of the week in bed, just really wasn’t feeling too brilliant. I woke up and there was a really big lump on my neck, and I thought perhaps [it was] glandular fever, and then I was told I actually had cancer.

I still really didn’t take it all in because I’m relatively young and I don’t smoke and don’t really drink, so I was really lucky it was only stage two. I know if had been further – three or four – it could have been a different story.  Listen to your body, because at the end of the day your body will tell you there’s something wrong, you’ve just got to find time to go to the doctor, no matter how busy your lifestyle is.

Until they find out what actually causes cancer in the first place, money’s got to be used for early diagnosis and save as many lives as possible.”

We’ll be back next month with all the latest news and features. In the meantime, you can keep up to date by subscribing to our News Feed.