Breast screening, Click to Cure and childhood cancer

Cancer Research UK
We discuss breast cancer screening, citizen science, and childhood cancer. Plus highlights from this year's NCRI Cancer Conference.

070-cancer-research-uk-podcast

This month:

  • Independent review of breast screening reveals both benefits and harms
  • New citizen science project launched to speed up cancer progress
  • Call for more co-ordinated childhood cancer research
  • Stand Up To Cancer raises over £7 million
  • Lung cancer awareness month gets underway
  • And we bring you highlights from the UK’s largest cancer conference.

Transcript

Welcome to the Cancer Research UK podcas​t, I’m Ailsa Stevens.

Breast Screening Programmes in the UK save lives but at a cost, according to the results of the independent breast screening review, commissioned by Cancer Research UK and the Department of Health. The Review found that while screening prevents about 1,300 breast cancer deaths every year, it leads to around 4,000 women having unnecessary treatment.

Having studied all the available evidence, the expert Panel concluded that, for each breast cancer death prevented, about three cases are overdiagnosed, meaning that a cancer is detected and treated through screening that would not otherwise have caused a problem in the woman’s lifetime. But at the moment there is no way of telling which women have a dangerous cancer that needs treatment, and which don’t.  

Professor Sir Mike Richards, the UK’s national cancer director, explains why the review was necessary:

Sir Mike: In recent years there have been a significant number of studies that have suggested that either the benefits of screening have been overstated or that the harms have been understated. Some of those have involved the review of randomised controlled trials, some have looked at more recent studies of implementation and to say the least they have come to diverse results. So this has become an area of high controversy and despite the fact that scientists are looking at the same evidence base, people are reaching very different conclusions.

Taking all the evidence into account, Cancer Research UK recommends that women continue to go for breast screening when invited. To find out more about the review and what it means for you visit the Cancer Research UK homepage, where you can find information on breast screening along with the full findings of the review.
Last month, Cancer Research UK launched Cell Slider - the first ever interactive website that allows the public to help with the analysis of real-life cancer data, in order to speed up lifesaving research.

The website features samples of tumours that have been treated with special stains that highlight certain molecules involved in cancer as part of a research project.  These molecules could reveal how a patient will respond to treatment. But spotting these highlighted cells is a slow process usually done by trained pathologists.

Cell Slider lets anyone try their hand at spotting cancer cells in these real-life research samples.  This is the first time real cancer data has been turned into a format that can be analysed by the public. By getting as many people as possible to take part, more samples will be analysed faster and more effectively, freeing up scientists to carry out other vital research tasks.

Amy Carton, senior innovation delivery manager at Cancer Research UK, tells us how you can become a citizen scientist:

Amy: This is a fantastic opportunity for you to come and get involved in real science. For the first time ever we’re putting our cancer research data online and with just a few clicks of your mouse and a few minutes of your time you can make some classifications for us that will massively transform the way we do analysis in future. Currently it will take between two and four years to analyse a data set from a trial, we run 260 trials a year. So imagine with the collective force of millions of you coming along and making classifications we think we can reduce the time it takes to just months.

If you want to get involved with Cell Slider then head over to the website - www.clicktocure.net

Experts are calling for an urgent change to approaches for treating and researching childhood cancers, to continue to save more lives from the disease.

Today nearly eight in 10 children diagnosed with cancer in Great Britain survive for five years or more, compared with fewer than three out of 10 in the 1960s. This has been thanks to conventional treatments such as chemotherapy, but these improvements have plateaued in recent years.

To try and address this, a new ‘treatment alliance’ that will bring together researchers, pharmaceutical companies, regulatory authorities and patients and their parents was proposed at this year’s International Society for Paediatric Oncology conference last month. The conference brings together over 2,000 leading childhood cancer specialists from across the globe for a three day meeting in London.

Cancer Research UK’s Dr Anthea Martin, who was at the conference, tells us about the future role of this new European initiative.

Anthea: At the conference a new initiative called the European Network for Cancer Research in Children and Adolescents, or ENCCA was announced. Funded by the European Union, this will bring together experts from across Europe to improve the treatment of children and young people with cancer though sharing knowledge and best practice and driving the development of new treatments. The ultimate aim is to help more children beat cancer.

On the 19th of October, Cancer Research UK asked the people of Britain to Stand Up To Cancer – and you didn’t disappoint.

The live show on Channel 4, hosted by Alan Carr, Davina McCall and Dr Christian Jessen, raised nearly £6.5 million to help bring closer the day when all cancers are cured.

That total has now risen to over £7 million towards research into new ways to treat and ultimately beat the disease.

So a huge thank you goes to everyone who took part on the night and made a donation. If you didn’t catch the show but still want to donate then just head to the website - standuptocancer.org.uk.

Later, we’ll hear about some of the highlights from this years’ National Cancer Research Institute conference in Liverpool.

But first, our reporter Greg Jones discusses the vital work that goes into supporting patients with lung cancer.

Greg: It’s the most common cause of cancer death in the UK, lung cancer kills almost 35,000 people every year and since more than eight out of ten of those deaths are down to smoking, it’s vital that the work of Cancer Research UK covers prevention as well as treatments.

Caroline Geraghty is one of Cancer Research UK’s information nurses, providing support and advice to people on all aspects of cancer. But before she joined the charity she was a nurse on a lung cancer ward.

Caroline spoke to me about her experiences on the ward and the role that smoking plays in many of the patients’ lives.

Caroline: When people are sent to clinic from their GPs with a query cancer, so when it’s suspected that they have cancer, one of the key questions that the doctor will always asks them is do they smoke. And invariably most of them will have smoked and the doctor will get a good history of how long they smoked for and many cigarettes they smoked. Now if those patients then went on and the investigations we did found out that they had cancer, obviously that we would be quite a big part of their discussion when they were told that they had cancer. Many people want to know why they’ve got cancer and with lung cancer, for many of those patients, unfortunately you can say you’ve got cancer because you smoked. So for many at that initial appointment there’s a shock but also for some there’s a “yep, I know why I’ve got it – I smoked and what do I expect” so they kind of understood that that was something that happened after they smoked. Now some will make a decision there and then to stop smoking, some will have stopped smoking many years ago and some will carry on. And some will carry on because they think “the damage is done, so why bother stopping?” Because there are very good reasons for them to stop in terms of how they cope with treatment. If you’re not smoking you can cope with treatment usually much better. Many, many patients have said to me I wish I hadn’t smoked. You’ve got to understand that lung cancer is usually found in older people, although I was seeing younger people – people in their 40s and 50s with lung cancer – but you’re talking about people who may have started smoking as children or when they were teenagers. And many of them say to me their absolute regret at smoking and that they knew it was doing them harm when it was known it was going to do them harm. If you’re talking to a 70 year old, when they started smoking - sometimes 50 or 60 years ago – it wasn’t well known that it would cause cancer. It's the younger ones – those in their 40s or 50s that I saw – they’re the ones who really understood that if they hadn’t smoked they probably wouldn’t have got this disease.

Greg: So what is being done to try and reduce the number of smokers?

Over the years, Cancer Research UK has campaigned tirelessly for legislation to combat the tobacco industry’s impact on global health.

Jean King is the head of tobacco control at Cancer Research UK, and I spoke to her about the campaigns she’s been involved in to try and reduce the number of people taking up smoking

Jean: Cancer Research UK has been active for many years in trying to reduce the toll that tobacco causes, because it causes so much cancer. And way back twenty years ago we were campaigning to get all advertising removed because we had research that showed it attracted young people to start smoking. And most people start smoking as children.
Then after that we realised it was time to get smoking out of enclosed spaces, because there was growing evidence that passive smoking if you like causes lung cancer, causes heart disease, and we had a big fight on our hands on that one because the tobacco companies realised this was going to start really affecting their business. And the public really came on side with this so when we did get smoke free legislation across the UK, finally England was last in July 2007, it was very well supported and I think people can’t imagine going back to smoke-filled restaurants and bars and so on now. After that we became aware that there was a loop-hole in the advertising ban because the displays were being lit up, the packets were becoming very glitzy and attractive again to young people. We did research and it was really very clear that these sorts of displays really do attract children and young people. The first campaign was called ‘Out of Sight, Out of Mind’, fortunately we were successful again. In 2009 the Health Act brings in a removal of point of sale displays in shops.
But we still have packaging and the tobacco companies have clearly spent a lot of time and money designing more and more imaginative and quirky and attractive packs. And when we show decision makers and parents and anyone who doesn’t go a buy tobacco regularly. When we show them the lipstick-shaped packs in pastel colours with little cigarettes with flowers on them inside they are shocked. Because it’s clear and again we have research evidence that proves that young girls find this attractive. Whereas the plain standardised packs that we’re campaigning for, they’re a turn off, they don’t want to be seen with them
So our latest campaign is called ‘The Answer is Plain’. We want the government to introduce plain standardised packaging like Australia is doing. And we will continue to campaign for this and other anti-smoking measures, because our smoking rates are coming down. But it’s up to us how quickly they come down and how many fewer people will suffer from lung cancer and other cancers that are caused by tobacco.

Greg: Lung cancer is the most common cause of cancer death, a title it has held for decades and is predicted to retain beyond 2030. We know that smoking plays the biggest role but the good news is it’s never too late to quit.
In fact, the sooner you give up smoking the better. After:
• 2 days - your lungs start to clear and your sense of taste and smell begin to return
• Between 2-12 weeks after quitting - circulation improves and exercise gets easier
• And after 10 years - your risk of lung cancer falls to about half that of a smoker and you have the same risk of a heart attack as someone who has never smoked.

That was Greg Jones reporting on Lung Cancer Awareness Month.

At the beginning of November, cancer researchers, doctors, nurses, policy-makers and patients from across the UK and beyond flocked to Liverpool for the 8th annual NCRI Cancer Conference, to take part in four packed days of talks and workshops. Our reporter Kat Arney was at the conference.

Kat: So I’m joined by Jessica Harris, health information officer and Henry Scowcroft, news and multimedia manager. What for you were the main themes that came out of this year’s NCRI conference, Henry?

Henry: I think in terms of the basic science there three things really leapt out, one was the avalanche of data that everyone’s talking about, the amount of genetic sequencing and clinical data that’s coming out that researchers almost seem to be feeling overwhelmed by this amount of data. The second thing was that we now have these targeted cancer treatments that seem to do well for a short amount of time and it’s starting to look like they’re going to be much more effective for patients in combination, but no one knows which combinations and under what circumstances so there’s a whole new level of work that needs to be done here. And finally another big theme here at the conference was just the genetic complexity of a individual patient’s tumour, how it changes over time and over treatment and researchers are just starting to get a handle on quite how complicated this is and how much work we need to do to understand how this happens and what to do about it clinically.

Kat: Because what impressed me was how far we’ve come in really such a short amount of time in our technology and the knowledge that we have about cancer but I guess we can talk later about the challenges of turning that into treatment. Jess, from a health perspective what were your key themes from the conference?

Jess: One of the biggest themes that stood out for me was all about early diagnosis, we had information both on the screening side and also what might motivate or block people from going to see their doctor if they notice any unusual symptoms. Which was some really interesting data from Jane Wardle’s team at UCL. They’ve looked at the levels of symptom awareness between the UK and different countries and found that they don’t really differ all that much, which is surprising because people thought that it might go some way towards explaining the differences in survival we have between those countries. We also saw the launch of the breast screening review, a huge review which looked into the benefits and harms of breast screening and really concluded that it has both benefits and harms and that women need to be properly informed about that before they make the decision to go for screening.

Kat: And about key highlights from the conference, for me Ken Anderson did a talk about myelomas for one of the plenary lectures and it was amazing to see just how much progress is being made in this type of cancer, that we don’t really hear much about. And then hearing about all these new drugs that are starting to come through and make a real difference. Henry, what were your key highlights?

Henry: I think for me one of the key sessions, was as I was talking about a session on the evolution of a tumour during treatment and how that changes how a tumour responds to treatment. We’re sort of really at the beginning of our understanding of how that happens. But one of the things that particularly stuck with me was Professor Charlie Swanton, who’s a CRU-funded researcher at the London Research Institute. And he was contacted by a brain cancer patient who wanted to put herself forward for having her DNA and different bits of that tumour sequenced and analysed to really understand what was driving it and hopefully to see if there were and treatments out there that could benefit her. And they managed to do this they got all the genetic sequence data done, they analysed it and they thought they’d found something that might help her, but sadly she died and they’re still pouring over this data to try and find out what made her tumour tick if you like, and they think they’ve found what it was, but Charlie’s key point is that we need to be able to do this within a timeframe that’s actually useful for a cancer patient. This isn’t just about publishing papers on genetic data, we need to do this to actually save lives.

Kat: Because that came up time and time again – how do we turn this huge amount of data into clinical benefits for patients that really desperately need it. And how about you Jess? What were your highlights and also the things that you think are challenging to the health and cancer research community still?

Jess: Well I think one of the main highlights for me was a really interesting session about cancer in the developing world. It’s not so common that we actually hear about cancer in the world outside of the research labs of the western world in this conference and I think it’s really fitting that, given that this conference showcases the best in cancer research at the moment, that we have a focus on the people who actually need the results from this just as much, if not in some cases more so, than we do over here. We heard that over half of cancer deaths actually happen in the developing world, which although is quite often seen as a modern disease of the western world due to our western lifestyles –of course lifestyles do play a big part – it’s important not to forget the wider picture. So we heard all about what can be done for breast, for oral cancer and cervical cancer in the developing world and how important it is that everything we do is based on good quality evidence so that we know that the things that we do are going to be worth the money that is spent on them. I think cervical cancer prevention is particularly exciting at the moment because, having got the HPV vaccination available, and it has now been funded through the GAVI alliance, which is an organisation which makes vaccinations more affordable for developing world countries. So it’s really great that that means a lot of countries in Africa and Asia and South America are able now to get HPV vaccination programmes and then, in conjunction with cervical screening as well, we could really start to see a massive reduction in cervical cancer rates in those countries.

Kat: So lots to think about, lots to look forward to in the coming years and lots of challenges as well. Thanks guys.

That was Kat Arney talking to Jess Harris and Henry Scowcroft.
That’s all we have time for now but we’ll be back in the New Year with all the latest updates.
In the meantime, you can keep in touch with us on facebook and twitter, and don’t forget to check out the science update blog – scienceblog.cancerresearchuk.org – where you can find out about all the latest news and views on cancer.