June 2011 podcast transcript

This month we bring you news highlights from the world’s largest annual cancer conference including two new melanoma drugs, and a new drug that could prevent breast cancer.

Also in the news this week - the number of lung cancer patients receiving surgery increases by 50 per cent in five years, mobile phones hit the headlines, and we take a look at a new review comparing cancer care in England to around the world.

Welcome to the Cancer Research UK podcast. I’m Angela Balakrishnan.

This month saw the world's largest cancer conference take place in Chicago in the US. At the ASCO conference, doctors and scientists from around the world gathered to hear about the latest progress in beating cancer from the lab and the clinic.

There was particular excitement around the results of clinical trials showing that two new drugs could significantly increase survival from advanced malignant melanoma – the most dangerous form of the disease, which urgently needs more effective treatments.

One trial was testing ipilimumab, a drug that stimulates the immune system, in combination with the chemotherapy drug dacarbazine, while the second tested vemurafenib, a so-called 'smart' drug that switches off a faulty molecule responsible for driving around half of all melanomas.

Professor Peter Johnson, Cancer Research UK’s chief clinician, told us about the significance of these new treatments for patients.

“For a very long time, melanoma has been a very difficult area with no really effective treatment – either chemotherapy, radiotherapy or other things. So it’s particularly exciting to have two new treatments coming along in quick succession.

The two are quite different. One of them – vemurafenib – is an inhibitor of an important kinase which signals within the cells. And the other – ipilimumab – is a means of inhibiting the immune ‘damping’ system that prevents the body from making an immune response to the tumour.

So these two treatments work in very different ways. Both of them seem to convey real benefit for patients with melanoma, albeit that neither of them unfortunately cures patients. But it’s a really important first step to see that we really can influence the biology of a type of cancer that up until now has been so difficult to deal with.”

A drug called exemestane has been shown to significantly reduce the risk of breast cancer in healthy postmenopausal women who are at higher than average risk of developing the disease, according to research presented at the ASCO conference.

Exemestane is an aromatase inhibitor – a type of hormone therapy currently used to treat certain types of breast cancer in women who have been through the menopause. But according to the latest research, it may also be effective at preventing the disease from developing in the first place.

Professor Jack Cuzick, a Cancer Research UK epidemiologist, talks about the significance of this finding.

“The results from the MAP3 study presented at ASCO are encouraging because they confirm our hopes and expectations that an aromatase inhibitor would have a major impact on the development of breast cancer based on what we’ve seen from the treatment studies using the drugs.

So this is very, very good news that in fact these hopes are positive. There also seem to be very few side effects. However the follow-up was only 35 months, so it may be too early to make the final risk assessment.”

Giving patients surgery for lung cancer can help to improve survival from the disease, but an NHS study in 2005 showed that just one in 11 lung cancer patients received surgery for their disease. But new figures show that this had risen to one in seven last year.

Lesley Walker, director of cancer information at Cancer Research UK, talks about the progress being made in using surgery to treat lung cancer.

“This year the lung cancer audit has very clearly shown that there is an improvement in the numbers of lung cancer patients who are getting surgery, and that’s absolutely key to us improving survival from lung cancer in the UK. We know we’ve been lagging behind in getting patients early enough, so that they are fit and well enough for surgery, and that surgery will give them a good chance of cure.

All patients, wherever they live, should be able to access the best quality treatment. What’s key about the lung cancer audit is that is will help us match the best survival rates in the world.”

The International Agency for Research on Cancer has warned that mobile phones should be categorised as ‘possibly carcinogenic’ but have not found evidence of a definite link proving that they cause cancer.

Our reporter Simon Shears asks Ed Yong, Cancer Research UK’s head of health information and evidence, whether we should worry about an increased risk of cancer from using a mobile.

Simon: The International Agency for Research into Cancer has recently grouped mobile phones into the 2B category – that they could possibly cause cancer in humans. What does this mean?

Ed: 2B is a “catch all” for lots of things that could maybe cause cancer, the evidence is limited, it’s not very strong but we can’t conclusively rule out a risk. So it’s worth remembering that there are two categories higher than that – 1 and 2A. 1 includes all the things that are convincingly linked to cancer like tobacco, asbestos and alcohol. 2A is for things that have strong-ish evidence, and 2B is for the rest of it.

It’s worth noting that there is a group 4, which is for stuff which does not increase the risk of cancer, and to date there is only one thing in that category out of about 500. So IARC err on the side of caution when they make their categorisations.

Simon: So the debate about mobile phones and cancer has raged for many years, but what does the actual evidence say at the moment?

Ed: The majority of the evidence tells us that mobile phones do not increase the risk of brain cancer or any other type of cancer. There have been a couple of small studies that have suggested otherwise, but that’s what the majority says. And that’s backed up by the fact that rates of brain cancer have stayed pretty stable over the past few years, even though the use of mobile phones has skyrocketed since the 1980s.

Also, scientists still don’t have a good idea about how mobile phones could increase the risk of cancer, and those explanations are vital when trying to work out if something is a risk or not. If you can’t explain how that risk occurs, then it makes it less plausible.

Simon: By putting mobile phones into this 2B category, saying it possibly could cause cancer, should people be worried or cautious, or think about their use of mobile phones generally.

Ed: I don’t think people should be too worried - I use a phone and I’m not taking any extra precautions. The Government stance is a precautionary one – if people want to reduce the time they spend on their phones then that’s fine, they can do that. And that children should be encouraged to minimise their call times because we don’t have very much data on the effects on mobile phones on children.

It is worth realising that the majority of evidence says that mobile phones do not increase the risk of cancer, although as I’ve said, there are some weaknesses in the studies that have been done so far that do not conclusively rule out a risk, hence the precautionary approach.

Simon: Going forward, are there any more studies coming up or in the pipeline to address these uncertainties?

Ed: There are two important studies that are currently in the works. One is called Mobikids, which is an international study looking at the effect of mobile phones on children – that’s a very important question that we don’t have an answer to yet.

And another really big one is called COSMOS – the UK’s involved in that as are a couple of other countries. That will look at the long-term effects of mobile phone use – so we’re talking over 20, 30 years what do phones do to people’s health? Obviously those studies will take some time to report, but the answers should be interesting.

According to a new review, England is lagging behind in key areas of cancer care compared to other countries, leading to poorer survival rates for people with some of the most common forms of cancer.

The report from the Kings Fund and Cancer Research UK compared the cancer performance of England to Canada, Australia, Sweden and Norway. It confirmed that survival rates in England from some of the commonest cancers are staying the same or even worsening, compared to other developed countries.

The study found this was because of later diagnosis of cancer, delays in accessing treatment and older patients missing out on treatment.

Sarah Woolnough, Cancer Research UK’s director of policy, talks about what this report means for health reforms in England.

“The report that was published last week highlighted that the UK doesn’t do as well as the best-performing countries in terms of cancer survival. It recognises that though our cancer survival has dramatically improved in the last 40 years, we sill lag behind the best in the world.

We believe the key reason is that we often diagnose cancer late in England, compared to our international counterparts, and also that there is inequality in access to the best treatments – particularly, at times, for older people.

The King’s Fund Cancer research UK report talks about the International Cancer Benchmarking partnership. This partnership is trying to better understand survival in a number of countries across the world.

We hope that in England and for the UK, we can learn lessons from the best-performing countries about how they diagnose cancer early, how they make sure that people get access to the best treatment, and that through this partnership there can be some sharing of best practice so that we can make strides to improve our cancer outcomes.

The Government’s health reforms have the potential to have an impact on the efforts that we’re making to diagnose cancer early. We have a new cancer strategy – that was published in January – and that commits the Government to saving an additional 5,000 lives each year by 2015.

We think a large part of that will be about diagnosing cancer early. Our message to the Government has been through the NHS reforms, they should ensure that efforts are redoubled to focus attention on diagnosing cancer early, and we will be monitoring the changes very closely to make sure that remains the case.

I think deprivation is clearly a factor that impacts survival. We know that poorer people often are worse on their cancer journey. We also know that the most deprived communities in the country often smoke more, and that will have an impact on cancer incidence and survival. So there’s much more we can do.

Partly it’s about encouraging everyone to go and visit the doctor if they spot unusual signs of cancer, or if they spot something that’s unusual for them. It’s also about raising awareness of the signs and symptoms of cancer among everybody in the population.

We need to get cancer diagnosed as early as possible in order that appropriate and optimal treatment takes place, and stands the best chance of success.

Improving cancer outcomes is an absolute critical priority for Cancer Research UK. Through our involvement in the International Cancer Benchmarking Partnership we are hoping to learn some lessons about how the best performing countries in the world diagnose cancer quickly and achieve their outcomes.

We want to bring that knowledge and understanding back to the UK in order that we can make recommendations to Government and drive through improvements in cancer outcomes, so that we can make our outcomes among the best in the world. That’s our ultimate aim.”

We’ll be back next month with the latest news and features. In the meantime, let us know what you think by emailing your comments to podcast@cancer.org.uk