July 2010 podcast transcript
This month, the cell’s biological ‘stopwatch’ could be used to predict how fast leukaemia will progress, spotting breast cancer early could save nearly a thousand lives each year, claims of a breast cancer vaccine breakthrough are over-hyped, and we announce plans to bring a genetic revolution to cancer treatment.
Cardiff University scientists, partly funded by Cancer Research UK, have found that the length of telomeres – the molecular caps on the ends of our chromosomes - could be used to predict how quickly leukaemia will progress.
Usually, telomeres get shorter as cells divide, and eventually get so short that cells stop dividing and die. But the researchers found that although the telomeres in leukaemia cells got shorter and shorter, the cells didn’t die – instead, their chromosomes started fusing together, causing genetic problems that fuelled the cancer.
Cancer cells from patients at the most advanced stages of leukaemia were more likely to have fused chromosomes than those with the less aggressive form of the disease.
Dr Duncan Baird who led the study explained how this could one day be used to help doctors treat people with leukaemia.
“What we believe is that telomere length may be able to provide that tool for the clinician to distinguish individuals that will or will not progress with their disease.
This is important because some individuals may be subjected to very aggressive chemotherapy treatment that they simply do not need. It's also important because individuals that may progress with their disease can be identified early and treated early, and that may help with their outcome.”
Nearly a thousand deaths from breast cancer could be avoided each year if short term survival rates in England matched the best comparable countries in Europe. These short-term survival rates are an indicator of whether the cancer is being diagnosed early or not.
Research this month from the National Cancer Intelligence Network showed that if England matched Norway and Sweden’s survival rates for breast cancer, 957 deaths could be prevented every year.
These figures reflect women whose cancer is diagnosed so late that they have a poor chance of surviving even a couple of years after diagnosis. When breast cancer is caught early, treatment is often more effective.
Professor Henrik Møller, the lead author, explained the statistics.
“The most likely interpretation of these new results is that a small proportion of breast cancer patients in any country present themselves to the healthcare system at a stage where their disease is very advanced and rapidly fatal. This phenomenon would happen in any population, but what seems to be the case is that it happens more frequently in England than in the other two countries.
The interpretation of that is most plausibly that it's due to patients with advanced breast cancer that presumably has gone unnoticed. In other words there is a delay – either in the awareness of symptoms and early diagnosis, or in the early stages of care.”
At the start of the month, American scientists revealed they had created a vaccine that could prevent breast cancer in mice. The discovery was hailed as a breakthrough.
But Cancer Research UK warned that we don’t yet know if this approach will work for women with the disease. Dr Kat Arney, science information manager at Cancer Research UK, explained how the vaccine works and why we’re being cautious.
“There’s some interesting science behind the headlines here, but it’s very early work that has been over-hyped in the press. So far, researchers have vaccinated cancer-prone mice with a molecule found in some breast cancers. They found that the mice were less likely to develop cancer after vaccination, but it’s a long way to go before we know if this will be safe and effective for use in women. “
Finally this month, Cancer Research UK revealed exciting plans that will one day bring the benefits of the genetic revolution to cancer patients across the UK. It’s called the stratified medicine initiative. Rachel Gonzaga spoke to James Peach, our director of stratified medicine, to find out more.
Cancer Research UK is forming a partnership to change the way that cancer treatment is delivered in the UK. This will be a chance for the charity to combine great research and patient care. Stratified medicine is when doctors treat different groups of patients differently, based on the genetic makeup of their disease. It's particularly relevant in cancer, because the genetic mutations that cause the disease are distinctive.
Researchers are identifying exactly which genes become faulty in cancer, and they're making more discoveries every month. Now they're in the process of linking mutations to treatments that target them. I'm here with James Peach, our Director of Stratified Medicine, to find out more.
“We're planning to show how genetic data can be incorporated in the NHS. In order to do this, we'll genetically test cancer patients at diagnosis in a few hospitals across the country in the next couple of years, as well as storing the results for research purposes. What this will do is two things – first, it will show that there is an affordable model we can roll out across the country. And second, it will gather vital research data to develop new treatments for stratified medicine."
Isn't this already happening?
"I'm happy to say that leading cancer centres and researchers across the country are already doing this, but it's only here an there and it's not routine across the NHS. So what we hope we can do in the next two years is prove a cost-effective, affordable, high-quality model that means that patients can benefit from this approach across the whole country."
Why is now the right time?
"Now is a very exciting time for genetics because the techniques of gene sequencing are now coming down in price to the point where it is possible to do this in the health service. On top of that, the drug companies and others have developed the drugs to target these gene faults. So we're lucky that at the same time sequencing is affordable, treatments are available. So Cancer Research UK is seizing this opportunity now to start proving that this can be done on a routine basis."
How much do we know about the genetic makeup of cancer, and how much more do we still need to find out?
"We have mapped many cancer genomes across the world, and we know many things about what causes cancer and what causes cells to proliferate and grow in an uncontrolled fashion. And this has led to some exciting discoveries such as cetuximab and erlotinib, both drugs that are targeted at certain mutations, so there are benefits for patients now. But this is only a small minority. What we'd hope is by combining routine service provision and research, we can accelerate this progress, and therefore develop more stratified treatments for patients."
When do we expect it to be rolled out across the UK?
"What we need to do is prove that this works. And I'd imagine that would take about two years to do from the start of genetic testing. Which means that I would hope that the NHS would be taking this on and rolling it out in two or three years time."
This sounds very expensive – do you expect the NHS will be able to cope with these new costs?
"That's a very good point, especially in the current environment. So in the early years of the programme, when we're proving the pilot, Cancer Research UK is putting together a partnership of funders from outside the NHS who will fund this programme in its entirety. So the NHS does not increase costs because of this. After this, we'll hopefully have proved the point that this is cost effective, and should be rolled out on the NHS."
And what are the next steps for Cancer Research UK in this project?
"We're working with our partners between now and September to produce more detailed plans about exactly what we're going to be doing, the funding and the rest of it. So we'll be back in touch with you about that."
We’ll be following the progress of our stratified medicine initiative on the podcast, so listen out for updates later in the year.
We’ll be back next month with all the latest cancer news. In the meantime, you can keep up to date by signing up to our RSS feeds at info.cancerresearchuk.org
Question about cancer? Contact our information nurse team