Landmark breast cancer study and the link between aspirin and cancer

Cancer Research UK
This month we talk about a study that could revolutionise breast cancer treatment, growing evidence on aspirin and cancer, and the latest cancer trends.

064-cancer-research-uk

This month, a landmark study could revolutionise breast cancer treatment, growing evidence on aspirin and cancer, obesity drives rises in kidney and womb cancers, lung cancer cases continue to rise in women, scientists develop first snap-shot of tiny brain tumours, and we shine a spotlight on 40 years of progress in bowel cancer.

Transcript

Welcome to the Cancer Research UK podcast. I’m Sally Staples.

A major study carried out by Cancer Research UK scientists could revolutionise the way women with breast cancer are diagnosed and treated in the future, by reclassifying the disease into 10 completely new categories based on the genetic fingerprints of individual tumours.

The research moves us closer to a time when breast cancer patients will be able to receive treatment more precisely targeted to the genetic makeup of their tumour.

Dr Harpal Kumar, Cancer Research UK’s chief executive, explains how these findings change the way we think about breast cancer.

“One of the things that people have struggled with is really getting to grips with the reasons why some women respond to treatments and some women don’t, why some women respond to treatments we think they shouldn’t respond to, and other don’t respond to treatments we think they should respond to.

And so clearly the sorts of understanding we’ve had up until now in terms of how we categorise breast cancers and therefore determine which treatments we give women have not been – until this point – sufficiently detailed.”

Professor Carlos Caldas also described how the findings of this study might help women with breast cancer in future.

“Breast cancer is a tremendous success story. When I graduated from medical school, survival from breast cancer was about 50 out of every 100 women diagnosed. And now it’s over 80 out of every 100 women. That is tremendous progress in 25 years.

But there is a price that we pay for that – it’s that we are over-treating a significant number of women. We’re not doing that because we are evil or anything, we over-treat them because we’re trying to offer the benefit across, and we can’t precisely define the ones that will benefit.

Just that if we could identify sub-groups where they have such good outcome that we could spare them treatment, instead of adding more and more toxic treatments, that would have enormous value for women. So that would have a very great impact by actually preventing women from receiving unnecessary treatment.”

Three large new studies looking into the effect of aspirin on cancer have shown that the drug may prevent some cancers, and can potentially stop the disease from spreading in the body.

The latest research adds to the evidence that, for certain age groups, taking a daily low dose of aspirin for several years can help cut the risk of oesophageal, bowel, stomach and lung cancers.

Professor Peter Johnson tells us what to make of this new research.

“For people already diagnosed with cancer, if they’re already taking aspirin it seems a sensible idea for them to continue. We don’t know yet if people who are at increased risk of different sorts of cancer – for example because they’ve inherited a tendency to it – have the same effect.

Taking aspirin does have some potential side effects, in particular there is some risk of producing internal bleeding, so anyone who’s thinking about taking aspirin probably should talk to their GP about whether it’s safe for them to do so.”

Cases of kidney cancer and deaths from womb cancer are both on the rise according to new figures released by Cancer Research UK this month.

In Great Britain the number of people diagnosed with kidney cancer per year has risen to over 9,000 for the first time.

Death rates from womb cancer are also up, with 18 per cent more women dying from the disease in the past decade. This follows a steep 43 per cent increase in the number of women getting the disease, although the good news is that the chances of surviving womb cancer are also higher today than ever before.

Experts believe that obesity could be playing a major role in driving up the incidence of both cancers.

Jessica Harris, health information manager at Cancer Research UK, tells us why it’s important to keep a healthy bodyweight and highlights the key symptoms to be aware of.

“Keeping a healthy weight is a great way to reduce the risk of kidney and womb cancers, as well as a whole range of other cancers like breast cancer and bowel cancer too. So it really can have a very big impact to keep a healthy weight.

And it’s also a great idea to get to know what’s normal for your body, so you can notice if anything does change. If anything is out of the ordinary you can go and see your doctor as soon as possible. Particularly for kidney cancer, look out for blood in your urine, and particularly for womb cancer [look out for] any kind of bleeding between periods or after the menopause.”

Lung cancer cases continue to rise in women with more than 18,000 UK women diagnosed with the disease in 2009 according to the latest figures from Cancer Research UK.

Lung cancer is still more common in men with more than 23,000 cases in 2009 but rates in men have been falling fast – while in women they continue to rise.

Cases of lung cancer mirror smoking rates around two to three decades earlier as more than 80 per cent of cases are caused by tobacco. And the differences in lung cancer cases for men and women reflect the smoking patterns in previous decades for each sex.

Hazel Nunn, Cancer Research UK’s head of health information, explains the reasons behind the different trends in lung cancer rates and why it’s never too late to give up smoking.

“Smoking rates have been falling in both men and women, but actually the smoking rates n men have fallen further and they began to fall before those of women, which is why we’re still seeing an increase in lung cancer rates in women.

Smoking’s the number one cause of cancer and causes about four in five cases of lung cancer. It’s never too late to give up smoking. Your health is always going to benefit. We know it’s difficult to give up but it’s really worth it in terms of the benefits you can see, both in the short and the long term.”

Cancer Research UK scientists have developed a technique they believe could help detect tiny secondary tumours in the brain, something that is currently not possible.

Scientists at Cancer Research UK’s Gray Institute for Radiation Oncology and Biology in Oxford showed that a special dye recognises and sticks to a molecule called VCAM-1. This is produced in greater amounts on blood vessels in tumours in the brain that have come from cancer in other parts of the body – known as brain metastases.

Dr Kat Arney tells us how this may contribute to progress in treating brain tumours.

“At the moment around on in ten cancer patients develop secondary tumours in the brain, and these can be difficult to treat. If they’re detected when they’re small, then there are options for surgery or radiotherapy, but often they’re not found until a later stage when they’re larger and harder to treat.

Although there’s still more work to be done to build on this early research and take it into clinical trials, this technique could help to increase survival in the future.”

April marks Bowel Cancer Awareness month, so the Department of Health has been running the Be Clear on Cancer campaign aimed at raising awareness of bowel cancer symptoms over the past two months.

As we heard earlier, poor symptom awareness is leading to late diagnosis of bowel cancer and early death from the disease.

Thanks to research, better treatments have led to the death rate from bowel cancer falling significantly over the past few decades - which is why it’s vital that the diagnosis is spotted as early as possible to offer patients the best chance of successful treatment.

Our reporter Ailsa Stevens talks to Josephine Querido, senior science information officer at Cancer Research UK, and Stephanie Moore from the Bobby Moore Fund, about how things have changed for bowel cancer patients over the years.

Ailsa: Josephine, can you just highlight some of the key developments in bowel cancer so far?

Josephine: We’re the largest funder of bowel cancer research in the UK and there have been loads of great developments in bowel cancer over the decades. We cover all aspects of research into bowel cancer from researching the causes of the disease to screening for the disease and also of course, importantly, treating the disease.

Some of these include developing new tests to screen for bowel cancer – we were involved in funding a trial that developed a new test for bowel cancer and that’s going to be forming part of the national bowel screening programme soon. We’re really pleased to see that because it could potentially save thousands of lives in the future.

We’ve also been looking into the key genetic causes of the disease over the years, and we’ve managed to pinpoint a gene that is responsible for a lot of cases of bowel cancer, and also a different gene that is responsible for a lot of cases of family bowel cancer – bowel cancer that runs in families. And this is good news because it means that these families can receive close monitoring for signs of the disease.

In terms of prevention, we’ve been involved in trials that showed that aspirin could help prevent bowel cancer.  And also we’ve helped to fund the largest study of diet and cancer, which showed links between bowel cancer and diet. We now know that a diet high in fibre helps reduce the chance of getting bowel cancer.

And then there’s the huge area of treatment for bowel cancer. We’ve helped change the way that people are treated in hospitals by testing combinations of chemotherapy and different drugs to treat bowel cancer, and this has had an impact and transformed the way that people are treated today.

Ailsa: What are the possible avenues of the future that are looking really promising at the moment?

Josephine: We’re funding a trial that’s looking at using keyhole surgery for bowel cancer, and this will hopefully be very beneficial for the patient because it will speed up recovery time – obviously it’s less invasive than a big operation. We’re also looking at testing different kinds of targeted drugs that are specifically targeted at genetic faults in bowel cancer.

Ailsa: Today I’m here with Stephanie Moore from the Booby Moore Fund which has so far raised £18.8 million in aid of life-saving research into bowel cancer. Stephanie – what exactly does the Bobby Moore Fund do?

Stephanie: Bobby died aged just 51 of bowel cancer. He, in fact, was misdiagnosed for four years which thankfully would not happen today. I founded the Bobby Moore Fund in order to raise awareness about the disease. It’s a very un-talked about subject in this country. Not in America, where they talk about haemorrhoids and bowels all the time. But in this country it’s surrounded by a tremendous amount of taboo.

So I wanted to raise the profile of bowel cancer, make it as “sexy” as breast cancer so that people talk about it and go to their doctors, be aware of the symptoms - mainly because that is going to save lives. But also to raise much-needed funds for research, because if we’re ever going to get on top of this disease, the research has to be done at so many different levels.

Ailsa: So how has the outlook for bowel cancer changed over the years?

Stephanie: Since Bobby was diagnosed and died of bowel cancer, things have improved beyond recognition. I meet people today who’ve had the same diagnosis as Bobby and who are living well with cancer. For example, it can be diagnosed earlier, it can be treated better – both surgically and in terms of chemotherapy. When Bobby was diagnosed, there was only 5-FU and folic acid on the market, and one or two other forms of chemotherapy – none of them worked for Bobby. 5-FU had been around since the 40s, and now there are many different types of chemotherapy and ways of delivering it, specific to the patient. Things have come on tremendously, also in terms of surgery. Now it’s not uncommon to have keyhole surgery, so people are up and eating on the same day as their operation, and going home three days later. If they need chemotherapy they have that much earlier, so their chances of survival if they have Dukes’ stage 3 or 4 are far greater. And also with Dukes’ stage 1 and 2 as well, it is such a good news story.

Ailsa: And what are some of the key signs of bowel cancer that people really need to be aware of?

Stephanie: There are two main signs for bowel cancer. One is rectal bleeding. If you were coughing up blood you would go to your doctor, so if you have any rectal bleeding, i.e. bleeding from the bottom, it could be piles – it probably will be piles, and then there is itchiness and soreness associated with that. But even if it is that and it continues, you should still be seeing your doctor.

The other major symptom is a change in bowel habit – probably looser stools. You know what is normal for you, so if you find that you have a massive change in bowel habit – so for example if you go to the loo every morning and suddenly you’re going five times a night, you’ve probably come back from abroad, or you’ve eaten something that’s disagreed with you, or you’re under a lot of stress – if that goes on for more than three weeks and you’ve been to your pharmacist and they’ve given you something to assist you, and it’s still going on for three weeks, you should go to your doctor.

So either rectal bleeding, or a change in the bowel habit, or both together, go to your doctor.  The doctor is quite used to talking about this – people just have to get over their embarrassment and go. We don’t want people dying unnecessarily of embarrassment. The chances are they’re not going to have cancer, but you just need to eliminate that.

Ailsa: The Bobby Moore Fund is a really important cause to the charity – what can people do to support the Bobby Moore Fund?

Stephanie: We still have a lot more to do because 44 men and women are dying every day of this disease in this country, and it is still the second-highest killing cancer. It shouldn’t be, but it is. And so research is very, very important as well as raising the profile of the disease.

One of the ways in which people can help us is that we do these amazing international projects every year. This is a win-win situation because people have to raise £5,000 for the privilege of coming away with us to a third-world country – this year it’s Brazil, the Chapada dos Veadeiros – where we’re building a school from scratch.

So we wild-camp, we live on the building site, during the day we build the school. There’s lots of interaction with the local people. It’s very poor there, it’s very uncommercialised, you don’t see another house, there aren’t any roads. And there is no work, there is no money so they barter. But we will build their school and we have the audacity to try and teach them to play football – football’s a big part of what we do.

We lay down a football pitch and there’s netball, so there’s lots of sport involved. And then on the last day we hand the school over. And half of that £5,000 stays here for research.”

We’ll be back next month with all the latest news and features. In the meantime, you can keep up to date with our Science blog – that’s scienceblog.cancerresearchuk.org