The latest on skin cancer, patient referrals and the fight against tobacco

Cancer Research UK
We explore skin cancer rates, how patients are referred for cancer tests, and the latest developments in our standardised tobacco packs campaign.

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This month:

  • Rates of skin cancer soar among the middle-aged, as our scientists launch a new study into the risks and benefits of sunbathing
  • High iron levels plus a faulty gene can lead to bowel cancer
  • ‘Worrying’ variation in how often GPs refer patients for cancer tests
  • We catch up on the latest developments from our plain packaging tobacco campaign
  • And we speak to Cancer Research UK scientists studying how chemicals found in plants could be used to fight cancer.

Transcript

This is the Cancer Research UK podcast, I’m Henry Scowcroft.

Cases of malignant melanoma – the most dangerous form of skin cancer – have soared among middle-aged Brits, according to our latest figures.

Each year, almost 2000 people in their 50s – about five every day – are now diagnosed with the disease – that’s compared to fewer than 500 a year in the 1970s.

We spoke to Yinka Ebo, our senior health information officer, about how people can protect themselves from melanoma, and why keeping an eye out for early signs of the disease is so important.

Most cases of skin cancer are caused by overexposure to UV rays from the sun or sunbeds so the important thing is to avoid sunbeds and enjoy the sun safely. And you can enjoy the sun safely by making sure you use shade, clothing and at least factor 15 sunscreen applied generously and regularly when you’re out in the sun. We know that when cancer is diagnosed at an early stage it’s normally easier to treat and the treatment is more likely to be successful. So generally it’s a good idea to be aware of how your skin normally looks so you’re more likely to notice any changes that could be signs of skin cancer. And if you do notice a change in the size, shape or colour of a mole or normal patch of skin then just make sure you get that checked out. It may well not be cancer, but if it is then it could make a massive difference to the outcome.

Also this month, we announced a new Cancer Research UK study to delve into the relative benefits and risks of spending time in the sun.

Too much UV radiation from the sun or sunbeds leads to sunburn, and can cause skin cancer. But lower levels of UV can have benefits– it helps our bodies to make vitamin D, which is essential to keep our bones healthy.

The new study is recruiting volunteers in the Greater Manchester area, and will use simulated sunlight to work out how different levels of UV affect different skin types, and find out how much is too much.

Dr Kat Arney, Cancer Research UK’s science information manager, explains how it will help solve years of controversy over vitamin D, the so-called ‘sunshine vitamin’.

So we all need vitamin D to keep us healthy and we make vitamin D through exposure to sunlight. But the problem is that too much exposure to UV radiation from the sun or sunbeds also increases the risk of skin cancer and particularly malignant melanoma, which is the most dangerous form of skin cancer. So we need to work out how to get the balance right between getting the right amount of sunlight but no increasing the risk of cancer. And the trouble is it's not one size fits all. We all have different skin types which means the same amount of sunlight might make different amounts of vitamin D in different people. so a study like this is really important for getting tot the bottom of, how much sun light does a person need to make enough vitamin D to keep them healthy.

High iron levels in our guts could help trigger of bowel cancer – but only when a critical anti-cancer gene is also damaged, according to a fascinating new study by a team of Cancer Research UK scientists.

The researchers, from the University of Birmingham and the Beatson Institute for Cancer Research in Glasgow, looked at mice who had a faulty copy of a gene called APC, which is damaged in 8 out of 10 human bowel cancers.

They found that, compared to normal mice, those with the faulty gene were two to three times more likely to develop bowel cancer, but only when fed diets high in iron.

In contrast, mice with a faulty APC gene, who were fed a low-iron diet, didn’t develop bowel cancer at all.

Dr Emma Smith, Cancer Research UK’s senior science information officer, explains how this discovery might one day be used to help prevent bowel cancer.

This study highlights that for those at high risk of bowel cancer, lowering their iron levels, say by eating less red meat or maybe finding ways to mop up the iron, might be an effective way of preventing bowel cancer ever developing. This is the third most common cancer in the UK so this study has the potential to benefit a lot of people.

New figures released this month by the National Cancer Intelligence Network (or NCIN) have revealed wide variation in the numbers of patients with suspected cancer sent for cancer tests by different GP practices across England.

The figures suggest that the number of patients being referred could range from under 830 to over 2,550 in every 100,000 people a year.

They also show wide discrepancies in the number of patients referred to hospital who then go on to be diagnosed with cancer, suggesting that not all GP practices are as good at spotting the early signs of cancer.

Sarah Woolnough, our director of policy and information, tells us why these findings are so worrying.

The really stark variation is worrying because even though GP practices naturally vary in the patients that they serve, some patients will have an older patient population others will for example be based on a university campus, and so the groups of people that come to see the GP will naturally differ. Still the variation we’re seeing suggests that it’s not just due to differences in the patient population the GP practice is serving, it’s also the course of action that some GPs are taking and others aren’t. We want all patients suspected of having cancer to be seen, treated, referred, promptly and appropriately by their GP.

This month saw two major developments in our quest to strip cigarette packs of their glitzy style and branding, making them less attractive to kids – a campaign we’re calling ‘The answer is plain’.

These came as disturbing new figures showed that more than eight out of ten smokers and ex-smokers regret ever taking up the habit, and over seven out of ten admitting they started as teenagers.

Our reporter Paul Thorne, caught up with Robin Hewings, Cancer Research UK’s tobacco control manager, for an update.

PAUL: So I’m here with Robin Hewings. Cancer Research UK’s tobacco control manager. Robin, the Department of Health consultation on plain tobacco packaging closed on August 10th and Cancer Research UK was running a campaign about this issue, can you tell us how the campaign’s gone?

ROBIN: The campaign has been really exciting and really fun and we’ve been really gratified when speaking to Cancer Research UK supporters, how interested they’ve been in the campaign, how many people have signed up to the campaign, so just under 80,000 have. I think when people sign up they don’t just do it very straightforwardly, they want to think about it and make sure they’re making the right decision, and so we’re really pleased so many people have helped the campaign in that way. And we know that’s something that will have a real impact with the Department of Health and with MPs as well.

PAUL: And so we’ve submitted our response along with the 80,000 signatures. What’s next? What can we expect the Department of Health to do from here?

ROBIN: Well the Department of Health will be reviewing all the responses they received, reviewing our own response. I think what was very striking to me was how important Cancer Research UK’s original research has been in developing our understanding of plain packs and that’s absolutely right given that we’re Cancer Research UK. And also how unimpressive the tobacco industry’s arguments are but also what we can expect next and what we’ve already seen is a massive tobacco industry reaction to this. They really really hate plain packs because it makes their products less attractive, which is a good thing, and we’re going to see a lot more of them fighting back against it.

PAUL: And so speaking of the tobacco industry, we know that a week after the Department of Health consultation shut, the Australian government, which is looking to be the first country in the world to roll out plain packaging, was taken to the Australian high court by the tobacco industry. And what was the decision there, what was the outcome of that court case?

ROBIN: The tobacco industry lost and the Australian government won and that’s the highest court in Australia so that’s a definitive decision. And obviously it’s and Australian court it doesn’t have any direct influence over the law here, but what is striking is that the tobacco industry was essentially using pretty similar arguments to the ones they would be using in relation to any legislation that happens here in the UK and its clear that they lost. And that’s in many ways a similar country with a similar culture and with very similar laws on this issue. So while it doesn’t have any direct relevance it does just give us real heart for the future. And what it also shows is that the tobacco industry, who always mount these legal actions and always say they’re very very confident of victory and then they basically always lose and I think that’s something we should bear in mind when they say that this is an illegal thing for the government to do that’s kind of what they always say and I think we should remember that.

PAUL: So would you be expecting that similar argument to rear it’s head over here in the UK and they’d be looking at threatening legal action against the UK government if they proceed with this?

ROBIN: That’s exactly right. They’ve already said that if the government goes ahead with this then they’ll take the government to court. They’ll do that at European level they’ll do that in a number of different ways and with the World Trade Organisation again with a couple of different arguments they’ll be using. But they did the same thing in relation to removing display of tobacco in shops where they took the government to court and lost. They said that the ban on vending machines was illegal and again, they lost. What it’s really about it intimidating governments so that it’s much harder for them to take action on tobacco. Whereas normally the government passes a law, Parliament agrees and then that’s the end of that. The tobacco industry is always keen to delay things for as long as possible and to make it as difficult as possible for the government to take action to reduce the harm from tobacco.

PAUL: So do we have any idea of when the Department of Health might respond to this and the next time frames for tobacco plain packaging in the UK?

ROBIN: The time frames for this are not clear. But what we would like is for them to act as swiftly as possible and we think its reasonable for them to introduce legislation on this next summer if they really get a move on. And that’s good because it means we can make progress on this issue and start protecting children from tobacco marketing as quickly as possible.

Broccoli, coffee, red wine and chocolate often make the headlines – either for their supposed cancer-causing - or cancer-fighting - properties.

But these so-called “superfood” stories are often misguided or over-hyped. Is there ever any truth in the idea that the foods we eat might somehow be beneficial in preventing or treating cancer?

Our reporter Ailsa Stevens, spoke to a team of Cancer Research UK scientists at the University of Leicester, who are using cutting-edge science to try and find an answer.

AILSA: Today I’m at the University of Leicester, where I’m joined by Cancer Research UK’s Professor Will Steward, Professor Karen Brown and Dr Lynn Howells, who are investigating the potential of several chemicals found in foods to either prevent or treat cancer.  So Dr Howells, we often hear about the cancer-fighting properties of various food-stuffs in the news. What’s the thinking behind this area of research and how much of this is hope versus hype?

LYNN HOWELLS: Well there’s a lot of evidence that certain countries have lower rates of different types of cancers and the thinking is that a lot of this decreased incidence in certain types of cancers is due to dietary constituents. And based on that evidence, for example in India there’s a very low incidence of bowel cancer, we take certain foods from the diet and investigate them in the lab. And we have more and more convincing laboratory evidence to suggest that certain dietary constituents, such as in particular curcumin which is derived from the spice turmeric, can actually have cancer fighting properties in the bowel. Our interest really is to try and take this from the lab and apply it in a clinical setting to see whether or not it really does have a potential benefit for patients.

AILSA: And so what are some of the other foodstuffs that you’re all researching at the moment?

KAREN BROWN: Our main focus is on curcumin which is founding turmeric and resveratrol which is found in grapes, red wine and peanuts. We do work on some other compounds but at the moment we’re trying to optimise the development process for cancer chemopreventive agents that can ultimately be used in patient populations and we’re using these two compounds as model agents to optimise this development strategy.

AILSA: What sorts of trials have you got going on at the moment and what research is happening?

LYNN: One of the main trials we’ve just started is using curcumin capsules and combining it with chemotherapy for patients who have bowel cancers that can’t be removed by surgery.  And this is kind of happening in two different phases. So first we need to know that its actually safe to give to patients in combination with their chemotherapy so we’re starting off with a really low dose, one tablet a day which equates to about 500mg of curcumin a day. We’ll give that to three patients prior to their chemotherapy starting and they’ll continue to keep taking that thoroughout their chemotherapy. And we’ve successfully had three patients go through this first part of the trial who toleratig the curcumin in combination with the chemotherapy very well. And they’ve had partial responses which means a shrinking of their cancer by a defined amount. We’ve also given the next three patients one gram of curcumin a day and they’re also doing well. We’ve not done the CT scans yet so we don’t know how they’ve responded to the treatment as yet. And we’ve just recruited a patient to the highest dose which is three grams of curcumin a day. So the trial’s progressing well, and hopefully one we get to the end of this initial stage we can look at a larger population of patients and we can compare those patients who are having FOLFOX only with those who are taking the curcumin as well.

AILSA: And so what areas of research are you most excited about at the moment and what are your hopes for the future?

WILL STEWARD: We’re very excited about the curcumin trial with the colorectal patients both because we think it might improve the outcome but also because it just might possibly reduce the toxicity of the chemotherapy. We’re also doing a trial in pancreatic cancer with our surgical colleagues where we’re adding a chemical derived from freshwater fish, adding that to chemotherapy, and early results again are looking promising so we’re expanding that to a larger number of patients at the moment. So those are two unique trials that we’re doing her looking to enhance chemotherapy with food and animal derived products.

KAREN: And we’ve also got data from laboratory studies showing that resveratrol from red wine – a low dose equivalent to what you might get in a large glass of red wine – can prevent colorectal cancer in some of our models. But only if you have it with a high fat diet, which is probably what most westerners would have, a reasonably high fat diet. So that’s really exciting and we’re looking at the mechanisms behind that at the moment.

AILSA: OK so that could explain some of the things we’re seeing with a mediteranian or a French diet?

KAREN: Definitely. That’s where the idea about, well all the effects, the cardiovascular and the anti-cancer effects come from that in the Mediterranean countries they do have well lower incidence of cardiovascular disease definitely.

AILSA: Well it’s been a real pleasure talking to you all. It sounds like there is some really exciting research going on in this area so hopefully we’ll see some of those results coming through soon.

That was Ailsa Stevens, talking to Professor William Steward, Professor Karen Brown and Dr Lynn Howells at the University of Leicester.

We’ll be back next month with all the latest news, but in the meantime you can stay up to date by following us on Twitter – we’re @CR_UK – or on FaceBook – we’re facebook.com/cancerresearchuk. See you next month.