Progress in prostate cancer, skin cancer warning
Kat: This is the Cancer Research UK podcast for September 2013. This month we’re discussing a huge genetic study looking at the causes of cancer, and good news for men with advanced prostate cancer. Plus, we unpack the latest skin cancer statistics. And we’ve got this month’s heroes and zeros.
Hello and welcome, I’m Dr Kat Arney, and with me to discuss the latest news is Henry Scowcroft, News and Multimedia Manager at Cancer Research UK.
Now the first study to kick off with is a huge new study from the Wellcome Trust Sanger Centre – it was published in Nature this month – and they’ve been looking at the fingerprints of different types of DNA damage in different tumours. Now this is thousands of tumour samples from thirty different types of cancer, but what did they do, Henry?
Henry: So this is a really interesting study, and what they’re trying to do is look for the way in which different types of process cause damage in the DNA that leads to cancer. Now the different processes at work are simple things like ageing but also UV light from the sun or carcinogens from tobacco smoke. They already had an inkling of what some of these fingerprints might look like, and they’ve developed a computer programme that could look through large quantities of DNA data from some of these big projects like the International Cancer Genome Consortium – a big project to map the DNA of hundreds of different patients’ cancers. And they’re looking for common signatures in these that might give clues for different causes of cancer.
Kat: Like characteristic spelling mistakes?
Henry: Characteristic spelling mistakes is a good way of putting it – like the errors that would be introduced by different types of typewriter, there are different ways of writing the stuff. They didn’t analyse any new DNA in this project. A PhD student at the Wellcome Trust Sanger Institute essentially contacted the owners of many of these databases of large genetic data and asked if his team could run their analytical software onto all this data. So they were able to track down more than 7,000 individual complete DNA sequences from 7,000 patients’ tumours, across 30 different types of cancer.
They used the complex software to look for these patterns and they found at least twenty different processes at work that are involved in developing cancer. Now this is really interesting because some of these we knew about already – researchers had already spotted some time ago the signatures of tobacco smoke and UV damage from the sun. They spotted another fingerprint which was the tell-tale signs of what happens when we age. This was the most common signature across all the tumour samples, really reinforcing this idea that getting older is the most common thing that happens to us to give us a higher risk of cancer.
But amongst this there were some mysterious signatures, one from a DNA editing enzyme called APOBEC, and these are our innate defences against viruses. And it looks like somehow these get switched on, and we don’t know why and we don’t know when, and we don’t know how this is involved in cancer yet, so this is a big mystery we need to go and solve, and work out what’s going on here.
Kat: I do think this is a really interesting area, because the study did throw up some of the usual suspects, but it’s thrown up a whole load of interesting new avenues to explore. What’s the next step?
Henry: So the next step is to then go back to the lab and try and find processes in our cells that might be leading to some of the signatures that they couldn’t identify, and then start working out what switches these processes on or off, so it’s a huge window into understanding how cancers develop. The other thing to do is that we can start to understand now that we know what these processes are, we can potentially find ways to either prevent them happening or stop them happening once they’re already in process. And that could directly lead to ways to prevent and treat cancer. So it’s a really, really exciting study that lays the foundations for a huge amount more research.
Kat: It is certainly a really exciting study. Moving from the lab to people, this month Cancer Research UK released a whole bunch of data on our website that provides a comprehensive breakdown of cancer statistics by local area. So to find out a bit more our reporter Greg Jones spoke to Nick Ormiston-Smith, who’s head of statistical information at Cancer Research UK.
Nick: The Local Cancer Stats website is an area of the website where you look up information about your local area. You can search by postcode, local authority, healthcare area or constituency to find out information that’s relevant to you. So you can search for cancer incidence, cancer mortality, screening uptake, early diagnosis and smoking-related statistics.
Greg: Why hasn’t this information been available before?
Nick: All of this information is currently available but what we’ve done is bring it all together. At the moment, it’s spread around different websites and is available in different areas. So what we’ve tried to do is pull it together so it’s all in one place and it’s easy to look at an overview of an area rather than by topic.
Greg: So what can this local cancer stats website actually tells us?
Nick: At its simplest, it’s just giving you stats for a specific measure and comparing it against the national average. So, for example, is cancer incidence higher or lower in Bolton than the national average? And is it higher in Bolton than, say, Wigan? We can use local cancer stats to compare two different areas. Ideally, people that are working in public health around the country will be able to use these stats to understand the nature of their population – whether they’ve got lots of smokers, whether they’ve got an issue with screening uptake – and identify areas where they can improve, areas where they’re doing well and also identify areas that are similar to them where they could perhaps learn from.
Greg: How are you hoping the stats website is going to be used and who do you think will benefit from it?
Nick: We’re hoping that the website is going to be used by local commissioners, people that work in public health, policy makers, health professionals and people with an interest in improving cancer outcomes and cancer survival across the country – looking at data for their local area and making a difference to cancer survival ultimately by learning more about their population.
Greg: On the day we announced that the local cancer stats website was going up, we had a lot of people using this info0rmation to create league tables to see who’s doing the worst and who’s doing the best. Is that not what the stats website is there for?
Nick: This website is not about naming and shaming areas that are performing poorly. We just want to provide data in an open and transparent way so that local communities can understand what the issues are in their area, and hopefully can identify areas where they’re doing well, where they can learn from good practice and where improvements need to be made.
Greg: How is the website going to evolve and how will it be kept up to date with the latest information and statistics?
Nick: We’re hoping to update the website on a quarterly basis – we want the stats to be as up to date as possible and we want to expand the content and include more information. If anyone has got any ideas about what’s missing from the website as it stands, you can email us at email@example.com and give us suggestions about what we can improve on. We’re always working on making the website better and any ideas would be welcome.
Kat: That was Nick Ormiston-Smith talking to Greg Jones there. Now, statistics can tell us an awful lot of information about what’s going on, and they can also tell us good news stories. And one of the great news stories that come out lately is in prostate cancer survival, where we’ve seen a huge increase in survival for men with advanced, incurable prostate cancer thanks to new drugs. These are men who’ve been on clinical trials or have got new drugs through drug access schemes. Henry – what’s going on here?
Henry: So this was data from the Royal Marsden Hospital in London, and essentially they were looking back at how men had fared on the clinical trials and access schemes running out of that hospital. They found some really encouraging news. These are men who had advanced prostate cancer, so they were being treated to extend their lives rather than try and cure them.
Kat: And they’re resistant to the current hormone therapy treatments?
Henry: Absolutely. So they’ve already become resistant to hormone therapy and they’re being given drugs to give them more time with their families and keep them going for a bit longer. What they found is that compared to a decade ago, now these men are living for three times longer than they were before, when they have access to these new drugs. These are new drugs like abiraterone, which is a hormone-based drug that Cancer Research UK scientists helped to develop. And then three other drugs – enzalutamide, which works in a similar way, cabazitaxel, which is a chemotherapy drug, and a really interesting drug called alpharadin, which is a radioactive drug that can target prostate cancer that’s spread to the bones.
But there are some caveats on this. So this is very carefully selected men, who have been selected to take part in a clinical trial, so they are being treated very carefully and monitored very carefully, and will likely complete the full course of their drugs where they’re able to. So this isn’t saying we’ve already made a breakthrough, these are drugs that are still being tested. But it does show that these things coming through the pipeline, based on fundamental research int he labs and in the clinic, are starting to really change the outlook for men diagnosed with prostate cancer, and the future will be very different from how it is today.
Kat: Things have changed hugely over recent decades. My grandfather died of prostate cancer when I was very young, and it was just before even the first hormone therapy drugs had come into the clinic. And now we’re seeing this whole raft of new drugs available for men, so it is fantastic. It’s important to point out that these aren’t cures – what you would expect as cures. The average survival now is about 41 months, that’s three and a half years-ish, but this is compared to just over a year, that was ten years ago on these trials. So there is progress, and I guess hopefully once we can get these drugs out into the world...
Henry: Absolutely. And also some of the trials going on now are looking at using these drugs earlier in men whose cancer hasn’t spread so far. Provided those trials are successful, there’s potentially even more benefits from these drugs in future.
Kat: Thanks very much, that’s Henry Scowcroft.
Kat: The sun has certainly had his hat on this summer, and while most people are out enjoying the good weather, here at Cancer Research UK we can't forget that UV rays from the sun and sunbeds are the prime cause of malignant melanoma – the most dangerous form of skin cancer. And although long-term survival from melanoma has climbed significantly in recent decades, more than 12,000 people are diagnosed every year in the UK, and more than 2,000 people die from it. This month we released new figures showing a significant difference in the death rates from melanoma between men and women, so to unpick the facts and figures I’m joined by Matt Wickenden, our senior statistical information officer, and Yinka Ebo, our senior health information officer.
Matt: What the numbers show us are that death rates from malignant melanoma in men are 70 per cent higher in men than they are in women, and that's despite similar numbers of men and women being diagnosed with the disease each year.
Kat: So this means that if a man has melanoma, his chances of dying are actually higher than a woman with the disease.
Matt: Yes, that's right. So we know that overall, men have lower survival and it's also showing us that men tend to be diagnosed later, when we know that survival is less good.
Kat: What do we think are some of the reasons why this difference might be? You mentioned later diagnosis in men.
Matt: Yes, so we have data on the stage at which these people are diagnosed with melanoma for both men and women, and men are tending to be diagnosed later, and we think some of that might be men are worried about wasting the doctor's time, and possibly some other reasons that eventually mean that they're just putting off going to the GP...
Kat: Until they get hassled by their wife to go!
Matt: We want people to go as early as possible, because we know that survival for people diagnosed early is much better. If I could just add, I think one thing we haven't mentioned is that it's not just that men are putting off going to the GP with skin cancer. One thing the statistics have shown us is that even when men are diagnosed at the same stage as women, they still have lower survival, and so that opens up questions about what's going on there, what can research tell us about these issues. So Cancer Research UK is funding research to find out what the biological differences in malignant melanoma might be between men and women, which might help us understand are there different mechanisms in men and women, and are there new avenues for treatment.
Kat: Yinka, what's your take on this?
Yinka: So Matt's absolutely right – we know that when cancer's picked up at an early stage, it means there's less chance that it's spread so it's easier to treat and people have a better chance of surviving the disease. And the other thing to bear in mind is where it can develop. So we know it's more common in men on their back or their chest...
Kat: This is just melanoma we're talking about?
Yinka: yes, and in women it's more common on their legs. So for men it might be a little bit more difficult to spot a change in their skin on their back. As well as keeping an eye on your skin in general, which will make it easier for you to spot anything that's out of the ordinary, also getting your partner to check those parts that might be harder for you to see...
Kat: Or if you don't have a partner, maybe just a friend!
Yinka: Maybe just a good old friend to check you back or any other areas that might be hard for you to see, so if you do notice anything you make sure you go and get it checked out.
Kat: And what sort of thing should people be looking out for when we're talking about the early signs of melanoma?
Yinka: So the sort of things you should be looking out for are a change in the size, shape or colour of a mole or any normal patch of skin. Or if you notice anything that's just out of the ordinary for you, it's a good idea to get it checked out.
Kat: For example, things like moles growing or bleeding – that's definitely a warning sign.
Yinka: So moles that are either bleeding or crusting or a wound that's not healing, anything that's not normal for you, you should go along to your GP and get that sorted.
Kat: And also, obviously skin cancer we know is very strongly linked to sun exposure – to UV rays from the sun and sunbeds. Now the summer is still just about going, what can people do to protect their skin from the sun?
Yinka: So now that the sun has actually made an appearance and we all want to enjoy it, we absolutely can, but we all need to take care to enjoy it safely. What you need to do to make sure that you enjoy the sun safely is to avoid getting sunburnt. You can do that by spending time in the shade. In the UK the sun is normally strongest between 11am and 3pm, so that's a good time to spend some time in the shade and take a break from the sun...
Kat: Get under your beach umbrella!
Yinka: Yes, pop into a cafe, anything – just take a break from the sun! Pop on a long sleeved T shirt, a wide-brimmed hat, a good pair of sunglasses. And for the bits that you can't cover, then use plenty of suncreen, and try and choose one that has a minimum sun protection factor (SPF) of 15, and one that has good UVA protection, and that's normally shown with a high star rating.
Kat: So that's things we can do about skin cancer. Matt, I'd just like to have a little chat about maybe more philosophically, the story we've got here has come from looking at the statistics on skin cancer and seeing these changes in patterns, and it makes us think “What's underlying that?”. Why is it important to delve into cancer stats, or even just to collect them?
Matt: So what statistics do for us is allow us to see what's actually happening in the population. So in this case we were able to see that men are more likely to be diagnosed late, and that can really help us understand where we need to raise awareness and encourage people to go early. And it can help inform some of the big campaigns we've worked on, such as Be Clear On Cancer, which has raised awareness of lung cancer symptoms to ensure that people and their GPs know what to look out for.
As well as that, it can also help us understand what's causing cancers, or at least let us know when cancers are becoming more common, so we can look into what's behind that. For example, we did a story several months ago about oesophageal cancer, and by looking at a particular type of oesophageal cancer that's particularly linked to obesity, we were able to see that that was becoming more common. So it lets us look into those issues more, and inform what we do next in terms of helping people avoid the disease or perhaps coming up with new treatments.
Kat: And I guess, Yinka, the work of your team, that's all part of this effort isn't it?
Yinka: Absolutely. We know that around four in ten cancers can be prevented through lifestyle changes like keeping a healthy weight, not smoking, being active and eating a healthy balanced diet, as well as staying safe in the sun. So, like Matt said, statistics help us to spot these trends and where cancers are becoming more common, and what some of those causes might be.
Kat: There are also a lot of good news stories we can find in the statistics, aren't there?
Matt: Yes, so one of those good news stories was actually linked to skin cancer. Recently we showed that more than eight in ten people now survive the disease, which is putting it among some of the best survival rates of any cancer. So for people worried about their body and worried about any changes, we would say that there are very good chances that you'll survive – particularly if you're diagnosed early, nearly everyone will survive the disease. So statistics allow us to reassure people that they can influence their chances of surviving, and also help us to show that we have made progress and reassure people that there is a huge number of advances being made all the time.
Kat: That’s Matt Wickenden and Yinka Ebo. And finally, it’s time for our heroes and zeros. Our heroes this month are England's NHS Stop Smoking services, which have helped 20,000 smokers to kick the habit long term in the latest year figures are available, according to the British Medical Journal. Over the past ten years the number of smokers these services has helped has tripled, and although there are some worrying regional differences across the country, overall the stop smoking services save lives more cost-effectively than just about any other area of the NHS.
And our zero of the month is a plant called birthwort, also known as Aristolochia and the source of a chemical called aristolochic acid. Some types of birthwort are used in traditional Chinese medicine, but it's been banned since the early 2000s as it was found to cause a rare type of urinary tract cancer. Now researchers in Singapore have discovered that aristolochic acid causes characteristic signatures of genetic damage in cells. The findings highlight the need for even tighter regulation and monitoring of sales of birthwort, to help protect public health.
That’s all for this month, we’ll see you again next month for a look at all the latest cancer news. We’d also like to answer your questions in our podcast, so please email them to firstname.lastname@example.org, post on our facebook page, or tweet us – that’s @CR_UK. And if you’re listening to this on Soundcloud, please leave us a comment with your feedback. Thanks very much and bye for now.