Cancer deaths in men, surgery under the spotlight, and highlighting oesophageal cancer
Kat: This is the Cancer Research UK podcast for March 2014. This month, we’re taking a look at the latest worldwide cancer stats, highlighting the importance of cancer surgery, and discussing the issues around oesophageal cancer. Plus our heroes and zeros.
Hello and welcome, I’m Dr Kat Arney. First, it’s time to take a look at some of the top cancer stories in the news. This month we’ve seen concerning new statistics showing that global death rates for cancer are 50 per cent higher in men than women. Our reporter Greg Jones spoke to Matt Wickenden, Senior Statistical Information Officer at Cancer Research UK, to find out more about what’s going on.
Matt: So the latest figures for cancer worldwide show that men are 50 per cent more likely to die of cancer, and obviously that sounds quite alarming. One of the reasons behind this is that men are more likely to be diagnosed in the first place. Some of the issues behind this are things that people can do something about: things like tobacco, alcohol and obesity are all major risk factors for cancer. We know that, in the UK, more than four in 10 cases of cancer could be prevented through lifestyle changes. So in some ways there is a reassuring side to this that things are not set in stone and there are things people can do to help themselves. And obviously there are things governments can do to help, with public health campaigns that look at some of those issues – so stopping smoking is obviously a really important thing that the Government continue to support, both in the UK and all around the world.
Some of the cancers that men are getting are harder to treat, and they are cancers that are quite often linked to smoking – lung, pancreatic and oesophageal. They’re linked to smoking and they’re also still very difficult to treat in many cases.
The final thing behind these figures is early diagnosis, in many cases, gives you the best chance of being cured of your cancer. So people really need to be aware of unusual changes in their body, take notice of anything that doesn’t feel normal for them and, when they spot that, talk to someone and make sure you take action and go and see your GP. The chances are it’s not cancer, but it gives you the best chance of beating it if there is something there.
Greg: So which cancers, from a global perspective, are behind the higher mortality figures?
Matt: In terms of the higher figures in men, it’s bladder, liver, lung and oesophageal, which men are more likely to be diagnosed with. These are cancers that are harder to treat, and obviously being more likely to get it in the first place, if it’s a difficult to treat cancer, means men are more likely to be dying of those cancers.
Greg: We’ve actually provided this information through maps – the stats website that we have has now produced maps so people can go and have a look. What do these maps show us and what can they tell us about where the UK ranks against other countries in terms of cancer mortality and incidence?
Matt: We already had something on our website called the local cancer stats portal. What we’ve done with these global figures is build on that local intelligence and take that global. So we’ve got an interactive map which lets you cut it up in lots of different ways. We’re really keen for people not just to take the spin on it that we’re particularly interested in – some of the preventable things that we’ve already noticed in these figures – so you can look at it by the cancer type, you can also look at it overall across the globe, or you can click on a particular country, such as the UK, and see where we sit in terms of mortality for all cancers or lung cancer or a whole range of other common cancers. We really hope it opens up some questions so people can go and have a look themselves and then go and explore to find out more about it.
Greg: In the UK we have cancer registries and we have quite a good way of recording data about people’s cancer diagnosis. Is that true across the world? How reliable are those figures from a global perspective?
Matt: We’re quite fortunate in the UK in that we have almost 100 per cent registration of every single person diagnosed, and that gives us a really good picture of cancer in the UK – how many people are being diagnosed with different types and what are the trends. That’s really useful, certainly for us, to be able to look at what we can do to help influence things. So, if we see that a cancer is becoming more common, we can launch campaigns to try and do something about that.
Unfortunately, some other countries still have quite basic pictures of how many people are being diagnosed and dying of cancer. Unsurprisingly, some countries in Africa have almost no reliable information. We try to reflect that in the map we’ve produced with colour-coding and shading that reflects not just how many cancers there are in that area, but also how trustworthy the figures are and how much weight we should give to each of those. So hopefully that gives not just a rough picture of what’s happening around the world but we also have a better idea of how much emphasis we can put on what those figures tell us.
Kat: That was Matt Wickenden talking to Greg Jones. Surgery cures more people of cancer than any other type of treatment, and it can be used to prevent and diagnose cancer, as well as controlling symptoms, yet it’s rarely talked about in the media. To put surgery back in the spotlight, we commissioned a report from a team of independent academics at the University of Birmingham, together with the consultancy firm ICF-GHK, to look at the state of cancer surgery across the UK, and see where there’s room for improvement. Greg Jones spoke to Emlyn Samuel, policy manager at Cancer Research UK, to find out more about the vital importance of surgery in treating cancer, and what the report reveals.
Emlyn: Well surgery is the backbone of cancer treatment for many. It’s estimated to contribute to around five in every 10 cancer cures. If the cancer is caught early, in many instances a surgeon can cut it out, and that’s probably the most effective way of getting rid of cancer.
Greg: And obviously we see drugs hitting the headlines all the time – with a new treatment it’s all about the drug – things like surgery and radiotherapy don’t really get the headlines. Why is that, given that we’re saying it’s so important?
Emlyn: I know – they’re sort of unsung heroes of cancer treatments! I’m not too sure why cancer drugs get the headlines when actually surgery and radiotherapy are responsible for around nine in 10 instances where cancer is cured. So they really should get more of the limelight.
Greg: And we don’t give these treatments in isolation do we – it’s not like you have surgery or you have chemotherapy – presumably it’s a combination; it’s one part in the puzzle of how we try and treat someone with cancer?
Emlyn: Yeah, absolutely. Many of these things are done in combination and actually more research that’s happening is finding out better ways to work in combination together. So I think it’s fairly rare that you would have only one of these types of treatment to try and cure cancer. Although that might be the case in some circumstances, generally it’s a combination of the three.
Greg: So in terms of the report that Cancer Research UK has done, what has it been trying to find out and what has been the aim of the report?
Emlyn: We basically wanted to find out how cancer services across the UK are performing, what are the challenges, what are the opportunities and how can we improve cancer surgery services for patients in the UK.
Greg: And you’ve spoken to people not just in the UK, you’ve also spoken to people in other countries as part of this. So is it also about comparing how we perform relative to other countries as well?
Emlyn: Yes – the researchers we commissioned spoke to around 50 surgeons in the UK, but we also ran a survey that went internationally as well, and got responses from over 130 surgeons across the world giving their view on the importance of cancer surgery services, how they work and how they should be organised the best for patients. So it’s really good to get that international perspective as to how the UK fits.
Greg: And in terms of the key positives and negatives, what have we found out – what has the report told us?
Emlyn: Well it is quite a complicated picture actually because, unlike radiotherapy and chemotherapy which are primarily cancer-specific, surgery in itself is not and cancer surgery within that is just a part. So unpicking how it works, how it’s organised and how patients access those services is quite difficult. There have been really good advances in surgery over the recent years. For instance, the rise of key-hole surgery has been a really big improvement which has meant patients have spent less time in hospital and need less recovery time. But our report also shows that services in the UK are being stretched somewhat and that more support is needed for research to improve the services
Greg: How do we improve access to surgery, particularly for certain types of cancer that might be rarer?
Emlyn: This is where it’s quite difficult but also quite interesting, and one of the major themes of the report is looking at this issue of how to access the best cancer surgery services and whether they’re done in certain centres – so whether they’re centralised in certain centres across the UK or whether they should be provided in every hospital. Basically there’s no one answer. And actually, depending on the cancer type, services can be arranged differently. So, for example, with a really rare cancer type, there might be only a few experts in the country who are able to perform that type of surgery. So it makes sense that that would happen in small, specialised hubs. But that is not the case across the board for all cancer types, and actually, for the more common cancers, it might not be best to have them in specific hospitals but it might be a different way of arranging services to make sure patients can access them as easily as possible.
Greg: So are some of the next steps actually going to be that we need to do more research into better understanding some of the things the report has found?
Emlyn: Yes. In terms of Cancer Research UK, this was an independent report commissioned by us so we’ll now look at the recommendations that are provided in the report and see how we as an organisation can help address them – either ourselves or potentially in partnership with others – and there are many things to look at throughout this report. It covers quite a broad range of areas, with research being one of them and the need to improve and support more surgical research in the NHS. That’s a key part of it, but there are many different areas that we’ll look into going forward so watch this space.
Kat: That was Emlyn Samuel talking to Greg Jones. And finally in the news, we’ve just seen some sensational headlines claiming that eating meat may be as dangerous as smoking for middle-aged people. But should we believe them? To get the low-down on the science behind the headlines, I spoke to our health information officer Sarah Williams.
Sarah: The paper itself is quite interesting, it’s always useful to find out a little bit more about how our diet can affect our health. But one thing I would highlight is that some of the coverage is perhaps a little bit misleading, particularly comparisons with the risks of smoking. So the most striking finding was that when they compared people between the ages of 50 and 65, the people who ate a high protein diet with the people who ate a low protein diet, the high protein diet people had about a four times higher risk of dying from cancer during the period of the study. But – and this was the quite intriguing part – when they looked at people aged 66 and over, not only had that increased risk gone away, those people actually in the study seemed to have a reduced risk of dying from cancer. So it will be really interesting to see a little bit more research, maybe done in larger groups of people, to really try and unpick what’s going on there.
Kat: When it comes to the paper itself, can you unpick that a bit. Is this a robust study, is this a reliable study?
Sarah: The study, as with any study, is not perfect and there are some problems. It’s not got a great deal of people in, considering the types of outcomes – deaths from cancer – that they’re looking for. There are also questions about how much the way that they asked people about their diet, how accurately and how well that would reflect what those people continued to eat over the next 18 years or so while the study was in progress. So there are various things you could point at that maybe mean the results might not be reflecting a real biological effect.
Kat: So, basically, is smoking as dangerous as sausages, based on this paper?
Sarah: This paper didn’t directly compare smoking and sausages, or indeed any of the sorts of protein. What’s really important to remember, particularly if you’re a smoker or know someone who’s thinking of giving up smoking, is that giving up smoking is the best thing that you can do for your health. It is really is very difficult to over-state the harms of smoking. We do know that there are perhaps some small, moderately increased risks of cancer connected with specifically red and processed meat, but they’re in no way in the same league as smoking.
Kat: And do you believe it?
Sarah: It’s hard to say whether we believe it on the strength of one study. I’m a little bit of a cynic and I perhaps never really believe one study. What I really want to look at is the overall evidence and what that tells us.
Kat: And, broadly, what is the evidence on diet? What should we be eating to reduce our risk of cancer?
Sarah: So protein definitely still has a place in a healthy, balanced diet. It’s perhaps a good idea if you eat a lot of it to cut back on red and processed meat – things like beef, lamb and pork. But you broadly want to try and keep it simple. Eat plenty of fibre, fruit and vegetables, and try and cut back on red and processed meat, salt, and high calorie foods.
Kat: That was Sarah Williams. Now it’s time to turn the spotlight on oesophageal cancer – one of the fastest rising cancers in UK men, affecting around 8,500 people every year. Our reporter Flora Malein went to meet Tim Underwood, a cancer surgeon and researcher at the University of Southampton, to find out how we’re trying to beat the disease and to discover the reason behind the rise in rates.
Tim: Probably to do with our Western lifestyles. We are too heavy, we’re obese, we have reflux because of that, we smoke cigarettes, drink alcohol and we don’t eat appropriately. All the things that your doctor tells you you should do, you should do!
Flora: As part of your day job you’ll see a lot of patients – what would you say is one of the main issues for you when you see them? What’s one of the big problems for you as a surgeon?
Tim: I’ll go back a step. The biggest problem for me, the thing that keeps me awake at night, is the two-thirds of people that we can’t treat. At diagnosis they already have cancer that’s spread round the body and they’re doomed, really. We can give them chemotherapy, we can support them, but they’re going to die from their disease. And we need to do better for those patients. We also probably need to do better for the patients that we put through an intensive regime of chemotherapy followed by a massive operation – if I could put myself out of business, that would be a great thing.
Flora: Those are quite grim words in some ways. What could we do better? What needs to be done to help these patients?
Tim: Something that Cancer Research UK is doing is funding the International Cancer Genome Consortium work on cancer of the oesophagus. That’s a long title but what it means is that we’re beginning to understand every single DNA molecule within cancer of the oesophagus. We’ll understand the genetic blueprint of the disease. Every cell has a three billion basepair genetic code that builds the cell, and builds the organ and tissue. And cancers have the same code, but their code is wrong – it’s been mutated. We’re understanding how it’s been mutated, and from that we’ll probably be able to understand how we can devise better treatments, targeted to the patient’s individual cancer.
Flora: Is there anything else in terms of what people can be aware of?
Tim: Something that’s really important is to understand that long-term persistent heartburn is not normal. Everyone gets heartburn occasionally – that is normal – but if you’ve had heartburn every day for three weeks or more, or you’ve taken medication every day for three weeks or more, and you’ve never seen your doctor and not been investigated, pop down to your GP and ask them “Should I have an investigation, should I be worried?” Probably you shouldn’t, but if we can get people earlier, there’s a better chance of curing them. If we catch people with early stage cancer of the oesophagus, the five-year survival is around 95 per cent. With the late-stage disease, it’s less than 13 per cent. That’s a huge difference.
Flora: And is there any other research that’s going on to help diagnose people earlier with oesophageal cancer?
Tim: The gold-standard test is an endoscopy, which is a camera on the end of a tube that goes down your throat into your stomach, and we look down the lining of the oesophagus. Professor Rebecca Fitzgerald in Cambridge, who is incidentally running the ICGC programme, has developed something called the Cytosponge, which is a sponge on a string. You swallow the capsule with the sponge in it, it goes into your stomach, and the string is held outside the mouth. The sponge opens up in the stomach as the capsule is dissolved, and we can pull the sponge back up. It takes cells from the lining of the oesophagus with it, and we can analyse the DNA content of those cells to tell people if they are at risk of having cancer of the oesophagus, or one of the precursor lesions to cancer of the oesophagus – something called Barrett’s Oesophagus.
Flora: It’s not invasive, it wouldn’t hurt you?
Tim: I’ve done it twice and I’m still here. It’s far less invasive than an endoscopy, it can be done in a GP practice, and it takes five minutes. We filmed an episode of Embarrassing Bodies all about heartburn, where I swallowed the cytosponge for national television last week. It’s going to be broadcast in the next series, which starts on April 15th. I’ve yet to be told which episode it will be in, but if you watch Embarrassing Bodies from April 15th, one of them will have me in it, swallowing a Cytosponge.
Kat: And finally, it’s time for our heroes and zeros. Our heroes this month are everyone who’s played Genes in Space – our new mobile phone game that helps our researchers analyse real cancer data. We’ve had thousands of people around the world getting in on the action, and it’s not too late if you haven’t played it yet. The game is still available to download for free from the Apple App store and Google Play, so give it a go and help to beat cancer without having to put on a lab coat.
And our zeroes this month are the headline writers claiming that high dose vitamin C injections can help keep “cancer at bay” and give “chemotherapy a boost”. The stories are based on lab studies of the vitamin, and a very small study with ovarian cancer patients, which showed that high dose vitamin C injections might have a small effect on reducing the side effects of chemotherapy for women with advanced ovarian cancer. However, the study didn’t show any impact on survival and was too small to be convincing, and it’s certainly not enough data at the moment to support vitamin C injections as an effective treatment for people with ovarian or any other type of cancer.
That’s all for March’s podcast, 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.