Summer sun, anal cancer and teens on trials
Kat: This is the Cancer Research UK podcast for July 2014. This month – how to stay safe in the summer sun, the shocking anal cancer statistics nobody wants to talk about, and why we need more teens on trials. Plus our heroes and zeros.
Hello, I’m Dr Kat Arney and with me this month to discuss all the cancer stories in the headlines is our Senior Health Information Manager Jessica Kirby. One of the first stories I wanted to talk about was now that summer is finally here we’ve been having some good weather – everyone’s been out enjoying the sunshine - there have been a couple of stories about skin cancer and UV radiation. So there’s on particularly interesting story that I saw in the journal Nature which basically says that sunscreen is not the answer. What’s the story here?
Jess: This study really showed that while sunscreen does have a role in helping to reduce the amount of damage you get from UV exposure, it can’t prevent skin cancer on its own. And that’s something that we’ve actually known for a while from studies of how people behave in the sun. We’ve known that shade and clothes are really important, and probably more important actually than sunscreen. If you can’t avoid being out in strong sun then sunscreen can really help, or for areas where you can’t cover up with clothes. But it really just reiterates how important shade and clothes are for protecting your skin from sunburn and skin cancer.
Kat: Now this was a study from Professor Richard Marais and his team up at our Manchester Institute, and they were looking more at cells in the lab and the effects of UV radiation in the lab. Can you tell me a little bit more about what they were actually looking at?
Jess: They were looking at how UV radiation affects the cells of mice that had a particular mutation that put them at risk of skin cancer. Actually they found that UV rays target one of the most important genes in our cells that help to protect us from cancer – p53. And that’s really interesting because it shows how UV rays can actually lead to cancer development, by blocking the thing that is meant to protect us from skin cancer in the first place. They also did the same tests with areas that were covered with SPF50 sunscreen, and showed that sunscreen could delay that damage but it didn’t stop the damage completely.
Kat: So, basically, if you are out and about in the sun this summer, it’s important to seek shade, cover up. Should you even bother with sunscreen?
Jess: Sunscreen is really useful but use it as the last line of defence. Keep your T-shirt on, wear something that covers up your shoulders. If you’re outdoors, maybe at a concert, then wear a wide-brimmed hat to give yourself a bit of shade, and look out for patches of shade where you can. And if there’s areas where you can’t cover up with your clothes or if you can’t avoid being outdoors – if you’re playing sport for example – sunscreen can help then. But not as your first line, and particularly not if you then put it on and stay out all day, because that will lead you to damage your skin.
Kat: One of the things I find really hard is that I’m very, very pale and I burn really, really easily – it’s knowing that if it looks a bit cloudy out, am I at risk of burning? How can I find out if today is the day I should really make sure I’ve got everything with me to stop myself getting burnt?
Jess: You’re right not to rely on looking at the sky to see your risk of burning. UV rays can still penetrate through clouds and so you need to look at what’s called the UV index to tell you how strong the sun’s rays really are and whether you’re at risk of burning. It used to be quite difficult to find that information, although it is on weather forecasts, but you’d have to go out of your way to find it. But we’ve actually just made a new online app where you can look at what your skin type is, how sensitive it might be to sun damage, based on the colour and also how it normally behaves in strong sun – whether it burns or tans. And then the app just pulls through the UV index straight from the Met Office and gives you a quick glance as to whether you might be at risk of sunburn on any given day.
Kat: And hopefully some tips about what I can do?
Jess: And tips about how to protect yourself from the sun, yeah.
Kat: Can I just get that on my smartphone, so if you’re out and about I can go “ooh, I wonder if I’m at risk today?”
Jess: The app’s actually on the Nivea website at the moment. We’ve got a partnership with Nivea Sun to help us spread our messages about enjoying the sun safely, so you can bookmark that app from the Nivea website.
Kat: Great – so hopefully the sun will stay around in order for us to enjoy it. Another thing I wanted to talk about was something that we didn’t really see in the news this month – and that was some statistics that Cancer Research UK released showing that the rates of anal cancer have soared by about 300 per cent since the 1970s. As usual we put out this story, we tried to get media interest, and there was… nothing. What do you think’s going on here?
Jess: I think these stats are really shocking, and I was so surprised that nobody picked it up at all. I really though the media would be interested in talking about such a shocking rise in a type of cancer which nobody really knows about, but I guess maybe they were squeamish or embarrassed, didn’t want to talk about anal cancer. It’s understandable but this is a really serious disease, and rates are going up quite fast at the moment, so we think it’s really important that people know about it, and know what the signs and symptoms might be and how to reduce the risk.
Kat: It does seem unusual when it’s breast cancer everyone talks about breasts, we talk about testicular cancer – there’s a Brazilian mascot for testicular cancer called Mr Balls, which is basically a walking scrotum – I don’t know if you’ve ever seen that?
Jess: I haven’t seen it, no.
Kat: It’s certainly striking. But for some reason people won’t talk about anal cancer. What do we know about things like the risks and the symptoms?
Jess: Well many cases of anal cancer – but not all – are linked to a very common virus called HPV. It’s mainly sexually transmitted, but most people will get an infection with this virus at some point in their life.
Kat: This is the cervical cancer virus?
Jess: It is, yes, the same one that’s behind cervical cancer, as well as a few other types of cancer – penile cancer for example, and some types of mouth cancer too. So that’s a really, really common infection which people can spread either via sexual activity or by passing it around between different places on their own body. There are also lots of other ways it can be transmitted as well. So that’s one of the big causes, and actually now that we have vaccination against this virus we should hopefully see these rates of anal cancer dropping down in future, because we know that the vaccine can actually protect against anal cancers too.
Kat: At the moment the vaccination’s only available for young girls before they become sexually active. Is there an argument it should be given to boys as well?
Jess: The HPV vaccine is only given to girls, and it would protect men as well, but men who have sex with women are already protected to a certain extent against the virus by women being vaccinated, because if there’s less of the virus going around among women, then it’s less likely that men will get infected. That’s fine, but it’s not fine for men who have sex with men, because they’re not protected by the current vaccination programme.
It’s something that we think is really important because it could potentially raise an inequality between men who have sex with men and men who have sex with women. It’s something that the JCVI – which is the national group who look at who should be vaccinated against what – they’re currently looking at it at the moment and they’re particularly prioritising their calculations about whether they can offer the HPV vaccine to men who have sex with men as well, and we think that would be a really good step to protecting men who have sex with men from this virus. They’re going through the cost-effectiveness calculations at the moment so we really hope that they’ll be able to come out with a positive answer on that.
Kat: This story had a lot of taboos in it – it’s talking about anal cancer and anal sex, and the risks of transmitting this virus. Why do you think it is important that we try and talk about these things and not sweep them under the carpet?
Jess: People might not want to talk about it but it is happening. We study people’s attitudes towards sex and their lifestyles in relation to sex and we see from these studies that more and more people are having anal sex. That’s not the only way this virus can be transmitted, but it does raise the risk. And because we know more and more people are doing it, we can then see it starts to explain a bit more about why the rates of this cancer are starting to change. And I think the worst thing would be if somebody out of embarrassment or thinking that they shouldn’t talk about it was having a symptom and didn’t want to see a doctor or seek medical attention about it. That would be absolutely terrible, and that’s why we need to talk about this disease, so that people know what causes it and know how to reduce the risk, and also so that people know that if they’ve got something that’s out of the ordinary with their body, whether it’s bleeding from the bottom without any reason or any other change that’s not normal for you, just go and see your doctor – they’ve seen everything before.
Kat: And moving from a story that no-one wants to talk about to a story that everyone wants to talk about – we’ve seen yet another story about red meat and cancer risk. And this time it was red meat and breast cancer. I know we’ve heard stories linking red and processed meat to things like bowel cancer, but breast cancer’s a new one. What’s this one about?
Jess: Well this is a big study which looked at American nurses, measuring how much red meat and processed meat and all sorts of other types of food they ate over their lifetime, and then looked at how many of them got breast cancer. And what they found was that the women who ate the most red meat, they didn’t really find this for any other foods but particularly for red meat, seemed to have a higher risk of breast cancer. Well that seems quite strong, and the study does have some quite good strengths, but it doesn’t fit in with everything else we know about red meat and breast cancer from lots of other studies.
There have been loads of studies looking at this and they’ve all basically shown no link, so it’s a little bit unclear as to what’s going on here. We’ve got quite a good study, although it does have some limitations, seeming to show a link, and lots of other studies showing nothing. We think that on its own, this study isn’t enough to change the entire body of evidence that we already have about red meat and breast cancer.
But, as you said, we do know that too much red meat and too much processed meat raises the risk of bowel cancer and perhaps some other types of cancer as well, so it’s still a good idea to cut down on red meat – try and only eat a moderate amount and substitute it for things like chicken, fish, grains or pulses.
Kat: We do hear so much in the media about diet and cancer and it does seem to be their favourite thing to talk about. What is the best advice for a healthy diet?
Jess: The best way to keep your general health up and to reduce the risk of cancer through diet is to eat a general healthy balanced diet that’s packed full of fruit and veg, loads of fibre, not too much red meat, not too much processed meat –that’s things like bacon and sausages – and not too much saturated fat. That will help you keep a healthy weight, it will help reduce the risk of cancer and also risk the of lots of other diseases as well. It might not sound like really specific “you should eat a particular type of food in this quantity”, but it’s not an exact science. It’s really just a case of getting that healthy balanced diet, and eating foods which are going to help your body stay healthy.
Kat: It’s not going to make the headlines like “carrots cure cancer!”
Jess: It’s not going to make the headlines, but it’s what we know works.
Kat: Thanks Jess. And there’s more information about all those stories on our blog – that’s scienceblog.cancerresearchuk.org.
A new report from the National Cancer Research Institute, published in the Lancet Oncology, says that age limits on clinical trials need to be more flexible to allow more teenage cancer patients the chance to access new treatments. It highlights that, at the moment, too many teen patients are needlessly falling through the gap between paediatric and adult cancer trials.
Our reporter Alan Worsley spoke to Kate Law, our director of clinical trials, to find out more about what’s going on, and what Cancer Research UK is doing to change the situation.
Kate: I think there’s been a history without too much reflection on the rights and wrongs to kind of limit the population that gets onto trials. And it has been done for the good reasons of people being worried about safety, both of the young population and the elderly population. It really just was time to revisit that and think about why we were doing it.
Alan: In essence, what’s different in particular about teenage cancers?
Kate: Well I think we’ve started to understand more about the biology of the disease and recognise that some of the teenagers were having cancers that were actually more like childhood cancers; others were having a cancer that actually fitted them more into the adult category. And as we began to understand more about the biology it became increasingly inappropriate not to include them in trials of one or the other.
Alan: Would you say teenagers are sort of falling into the doughnut between childhood and adult cancers?
Kate: Yes – I mean that with every cancer that a teenager gets, as they fall into categories, we begin to understand them better and we can categorise them as an older form of a childhood cancer or a younger form of an adult cancer –and, therefore, treat them on a trial appropriately. We really couldn’t do that until we understood the biology better.
Alan: And this paper comes as a result – it’s a six-year study that has found that far more people are getting onto trials and being treated more appropriately, as you say, for their cancer type. What’s Cancer Research UK doing about this in light of this research?
Kate: This research was really important and I’m pleased and proud to say that Cancer Research UK was an early adopter. We picked up on the fact that there was some inappropriate age ranges onto our trials and we changed the forms, we put messages out among the researchers that they had to justify why there was an age limit – low or high – on any of our trials.
Alan: So a researcher would come forth with an idea – ‘I’ve got a new drug I want to try or some combination treatment for a particular kind of cancer and I’m going to say it’s between 18 and some upper age limit’. Is it true that Cancer Research UK is now saying ‘why did you pick 18? Would a 16-year-old with the same type of cancer not also apply?’ – is that how it works?
Kate: That’s exactly how it works. We have very clearly structured forms and also a very good dialogue with all of the clinical community. So these changes are very clear – they were discussed, they were absolutely supported by everybody in the clinical community, who also recognised that it was time for a change. That’s not to say there won’t be cases where they can argue their corner, if you like, and that’s about protection of all patients.
Alan: So how widely do you think these new guidelines will be adopted – is there pretty good hope that all cancer research funders will adopt these guidelines?
Kate: I think almost certainly. There is a challenge and that is that in rarer cancers, which are for children and young adults, we often have to do international trials otherwise they would go on for decades or more. The international community I would have to say is behind the UK.
Alan: So this is one where the international community is not up to speed with this sort of recognition that we need to rethink some of our age limits on clinical trials?
Kate: Yes – this is very much an international effort. The UK is ahead of the game but, when we do international trials, we are forced to compromise sometimes. There is a lot of effort going on with our UK researchers to chivvy, to persuade and to influence to change that internationally.
Kat: That was Alan Worsley talking to Kate Law.
Now it’s time for our heroes and zeros. Our hero this month is Arran Tosh, an amazing 13-year-old from Suffolk who died just five days after being diagnosed with a brain tumour. Arran had been one of our incredible fundraisers, raising money for research after his aunt was diagnosed with breast cancer. He vowed to shave his head if he reached his £1,000 target, and his total is now at more than £18,000. He was an inspiring young man and we send our deepest sympathies to his family.
And our zero is the Mail Online, whose coverage of a recent story about pancreatic cancer rates is a great disservice to people suffering from the disease. Earlier this week, we released new stats about how pancreatic cancer – one of the most devastating and hard to treat forms of the disease – is linked to two lifestyle factors: smoking and obesity.
Our story specifically dealt with two things that made pancreatic cancer more likely among otherwise healthy people. It said nothing whatsoever about how being overweight or smoking affected people currently living with pancreatic cancer. But the Mail Online ran a headline claiming that almost 40% of pancreatic cancer patients could protect themselves from the deadly disease by making simple lifestyle changes, and a summary including the phrase “A healthy weight and not smoking could help two fifths save themselves.”
This is a completely inaccurate portrayal of the story and potentially upsetting for both patients living with the disease, and the thousands of families who have been affected in the past. And despite us contacting the Mail, it doesn’t seem to have been changed.
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 love 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.