April 2011 podcast transcript

This month - tamoxifen could prevent breast cancer in women at high risk; new research highlights worrying differences in the results of bowel cancer surgery in England; at least 13,000 cancers each year in the UK are caused by alcohol; as under-18s are banned from using sunbeds, new figures show more than two under-35s are diagnosed with melanoma every day; and we celebrate success in our campaign to protect young people from tobacco.

Welcome to the Cancer Research UK podcast. I’m Ailsa Taylor.

Women at high risk of developing breast cancer could one day be given drugs to prevent them from getting the disease, according to an international panel of cancer experts.

In a review published in the journal Lancet Oncology this month, the panel agreed that if a woman is four per cent more likely to get the disease in the next ten years than most other women, she should be offered drugs like tamoxifen, even before signs of the disease appear.

Cancer Research UK’s Professor Jack Cuzick, who chaired the panel, explains more.

“The cardiologists figured out a long time ago that it’s better to identify high-risk individuals and provide preventive therapy rather than waiting for them to get a disease and try to treat it. If you went to your doctor with high cholesterol and he said ‘come back in a year and we’ll see if you had a heart attack’ you wouldn’t be very pleased, but in fact that’s still what we do in cancer.

Breast cancer is leading the way in terms of prevention and we’re trying to take some of the ideas from cardiology and bring them across to cancer. Mammograms now do detect cancer earlier, when it can be treated more effectively, but an even more effective strategy, I believe, will be to identify women at high risk and bring their risk down.

The use of drugs seems a bit strange in cancer at the moment, but the cardiologists have been doing it for a long time. Statins are routinely used, anti-hypertensive drugs are routinely used in men and women with high blood pressure, and they’ve been extremely effective at reducing deaths from these two causes – very impressive results that we’ve seen, and we’d like to bring those results over to cancer, starting with breast cancer.”

New research funded by Cancer Research UK has discovered worrying variation in the results of bowel cancer surgery across NHS hospitals in England, with some hospitals having many more patients dying immediately after surgery than others.

Researchers from the University of Leeds studied the outcomes of all patients who had major surgery for bowel cancer on the NHS in England over a nine year period from 1998 to 2006.

Dr Julie Sharp, science information manager at Cancer Research UK, talks us through the findings.

“For people that have had bowel cancer surgery, about 6 or 7 per cent of people were dying within 30 days of their surgery. Perhaps, not surprisingly, that was more common in elderly patients, people who had other disease, or who had an advanced stage of bowel cancer.

What was more worrying was that once the scientists allowed for all those different factors, they found that across England there was actually some variation – some hospitals had a much poorer survival rate. Whilst there’s obviously some concern around some of the hospitals that aren’t doing so well, it’s important to remember that this is really a first step, and we can only get improvements across the NHS if we have this kind of information.

So now this information will be added to, and it will be reported more regularly. And for those hospitals that are doing really well, the NHS will be able to look at those hospitals and learn lessons from them, and also look at what is actually going wrong in the hospitals where they have a poorer survival rate.”

A new report in the British Medical Journal, partly funded by Cancer Research UK, shows that alcohol causes at least 13,000 cases of cancer a year in the UK.

The study also revealed that alcohol has the biggest effect on cancers of the mouth, food-pipe, voice-box and pharynx – with more than 6,000 of these cancers caused by drinking. Alcohol also causes more than 3,000 bowel cancers and about 2,500 breast cancers every year.

The research is part of ongoing work by the European Prospective Investigation of Cancer (or EPIC for short) – the largest ever study looking at the links between lifestyle and cancer.

Jessica Harris, senior health information officer, tells us what health advice people can take from this research.

“Many studies over years and years of research have confirmed that drinking too much alcohol increases the risk of developing cancer, and that the more you drink, the higher the risk is. The good news is that the more you cut down, the more you can reduce that risk.

We recommend that people regularly drink no more for men than two small drinks a day – which is about 3 to 4 units – and for women, one small drink a day, which is about two units a day. At that level the increased risk is likely to be very small.”

Every day more than two under-35 year-olds in Britain are diagnosed with malignant melanoma – the most dangerous form of skin cancer.

The new figures from Cancer Research UK – released to mark the launch of our annual SunSmart skin cancer awareness campaign - showed that more than 900 15-34 year olds are being diagnosed with melanoma every year. Rates in this age group have trebled since the late seventies.

Caroline Cerny, Cancer Research UK’s SunSmart campaign manager, talks to us about this alarming rise and gives us her tips on how to enjoy the sun safely.

“Cancer isn’t typically a disease that affects young people. Generally your risk of cancer increases as you get older, so these figures are very worrying. Back in the 1970s, we saw that skin cancer was the seventh most common cancer for 15 to 34 year olds. Now it’s the second most common cancer.

Back in the 70s, package holidays to places like Greece and Spain became cheaper and much more accessible, and also sunbeds were introduced to the UK. It’s likely to be these trends of having a year-round tan and burning in order to get a suntan that’s leading to this explosion in skin cancer rates that we’re seeing now.

Some sun is good for us and we all need to make sure we go outside and enjoy the sunshine when it comes out – particularly in the UK when we don’t see it very often! But the most important thing is to protect yourself from sunburn. So make sure your skin never goes red in the sun.

There are a few easy steps you can do to do this – first of all make sure you spend some time in the shade when the sun’s at its strongest, usually between 11am and 3pm. Cover up, wear a wide-brimmed hat, and use sunscreen – put it on generously and regularly."

This month also saw the introduction of the Sunbed Act, which was passed last year after strong lobbying from Cancer Research UK. The legislation, which came into effect on April 9, now bans under-18s from using sunbeds.

Tracey Loftis, Cancer Research UK’s senior public affairs manager, tell us why this is an important first step towards protecting young people from the dangers of using sunbeds.

“The new legislation means that under-18 year olds will no longer be able to use sunbeds in England and Wales. It also means that if businesses let under-18s use sunbeds, then they will be liable for up to a £20,000 fine.

We’re absolutely delighted with this news because we think that it sends a clear message that using sunbeds increases your risk of developing skin cancer.

The World Health Organisation has actually reclassified sunbed use into its highest risk [category] for cancer, along with tobacco. Alongside that, we also know that if you use a sunbed for the first time before you turn 35 years of age, you can also increase your risk of melanoma by 75 per cent.

So we know that sunbeds are dangerous, we know that young people are still using them. So this measure is very welcome. We know that a quarter of a million children aged 11 to 17 use sunbeds, so what we need to have is this step in place to make sure that they’re not using sunbeds.

If we could go further, that would be fantastic. For example, we could make sure that all sunbed salons were staffed, we could make sure that health information is provided and displayed . They have these steps in Scotland, they’re bringing them in in Wales in October, so it would be really great if England could also take these steps.”

Lindsey Coane was diagnosed with malignant melanoma at the age of 21. She blames her cancer on sunbathing and sunbeds, which she started using as a teenager.

“I’d been using sunbeds from the ages of 17 or 18, going on regularly for about 6 to 9 minutes each time and I’d go on about twice a week. You’re carefree at that age – you don’t realise the risks for the future.

There was a section on the back of my left leg which would never tan, and my friend convinced me to go to see the doctor, because it was a white patch with a red dot in. So we ended up going to the doctor, and it turned out to be a halo mole. But in the meantime I’d had a mole on my left calf which was slightly painful, and I showed it to her. It turned out that was the more serious of the two.

I feel silly, almost, that I was so concerned about having a tan that I put myself at such risk. It’s not worth it – I’d never ever go on another sunbed.”

This month the government published a new tobacco control plan, aimed at reducing smoking rates and tackling the harm caused by tobacco.

As well as banning cigarette vending machines in October this year and removing tobacco displays in shops, the government said it will hold a consultation on the possibility of introducing plain packaging for cigarettes and other tobacco products.

Our reporter Paul Thorne investigates.

Paul: On the 9th March this year the Government announced its tobacco control plan for England. Called Healthy lives, Healthy People - the plan includes measures that Cancer Research UK has been calling for as part of its Out of Sight Out of Mind campaign since 2008.

Cancer Research UK welcomed the plan and campaign supporters were pleased to see the details finally released. A key announcement in the plan were regulations to put tobacco out of sight in shops in England. These will come into force for large stores such as supermarkets on April 6th 2012.
But the deadline for smaller shops has been pushed back from the previous Labour government's original date in October 2013 to April 2015.

As well as these two measures, removing shop displays of tobacco and cigarette vending machines, the government said it will hold a consultation on the possibility of introducing plain packaging for cigarettes and other tobacco products.

I asked Robin Hewings, Cancer Research UK's tobacco control manager to find out his reaction to the government plan.

“Overall we think the plan is a triumph for public health. It’s got new ambitions to reduce smoking more quickly than has been the case in the last few years, plans to remove displays of tobacco in shops, and the Government we know is actively consulting on bringing in plain packaging of cigarettes – all of which we think is really good.”

Paul: What sort of evidence is there that these measures will be effective in helping to reduce smoking rates?

“Overall it’s very clear that the countries with the best policies on tobacco control then have the lowest smoking rates, which feeds into lower rates of cancer and other serious diseases, such as heart disease. So the evidence overall is very clear.

With relation to these specific measures, we know from Ireland – who removed displays of tobacco in shops a couple of years ago – that they have already very quickly changed the way in which young people think about smoking, in ways that will have significant impact upon the extent to which they do actually smoke.”

Paul: What sort of evidence is there that plain packaging will help reduce smoking rates?

“It’s clear that the packaging is a really important tool for the marketing and promotion of tobacco, and we know that’s it’s important for the extent to which people do smoke. Documents from inside the tobacco industry have made it clear that they put enormous amounts of effort into making their packages as attractive as possible to as many consumers, and we know from work with people that if you take away that packaging, the cigarettes then become less attractive to people.

What we also know is that the tobacco industry uses the colours in their branding to suggest that some cigarettes are safer than others. So they package things as being white to imply that these are ‘mild’ cigarettes that won’t be nearly as addictive or dangerous to you as ones packaged with darker colours. But in fact all cigarettes are as dangerous as each other.”

Paul: Arriving at this point has taken several years of campaigning by the charity.

“The contribution by Cancer Research UK and its supporters over decades – and its predecessor organisations – is absolutely immense to reducing the problems caused by tobacco, whether it’s smoke-free legislation, or removing tobacco advertising from Formula 1 and other forms of advertising. Over the decades it’s been very important.

In the last few years it’s also been absolutely crucial to removing tobacco displays in shops and removing tobacco vending machines, and raising plain packaging up the agenda. So hundreds and hundreds – thousands – of Cancer Research UK supporters have got in touch with their local MP, they’ve written to their local newspapers, they’re signed petitions, and they’ve actually gone and met with people to make the case for why it’s important that the Government takes action to reduce the harm that comes from tobacco."

Paul: So Cancer Research UK supporters should rightly feel proud of the announcement. Do you think that amongst the wider community and the general population, there’s an understanding of just how dangerous smoking is, and why these sorts of measures are important?

“Cancer Research UK supporters should feel really proud for the work they’ve contributed to, and I think without them we wouldn’t be in the place we are today with the damage from smoking being much less than it was in the past.

What’s also true, though, is that people can take for granted that smoking is dangerous. What’s important is that there continues to be the mass-media campaigns that there have been in the past, which make the case that smoking is very dangerous in new ways, in ways that motivate people not to start, or to give up smoking. Because we’ve got to remember that smoking is very dangerous.”

That was Paul Thorne talking to Robin Hewings. You can find out more and get involved with our campaigning work at cancercampaigns.org.uk
We’ll be back next month with all the latest news. In the meantime, you can keep up to date by joining our Facebook group.