May 2011 podcast transcript

This month: Genetic testing could mean fewer women need breast cancer screening, patients in England get increased access to cutting edge radiotherapy, and a report highlights how government cuts could hamper cancer research in the future. Plus, new guidelines to improve detection of ovarian cancer are planned, and we take a look at the latest developments in brain tumour research.

Welcome to the Cancer Research UK podcast. I’m Paul Thorne.

Research, co-funded by Cancer Research UK, has found that using genetic testing to identify women at a higher risk of breast cancer could reduce the number of women who are screened, without reducing the number of cancers detected.

This new screening concept could reduce some of the risks associated with screening – such as false positive results and the subsequent anxiety this causes – as well as saving the NHS money.

Professor Paul Pharaoh, a Cancer Research UK expert in genetics and one of the team involved in the study, explains more about what this research could mean for women.

“At the moment, women are invited to the National Health Service breast cancer screening programme based on their age, such that women from the age of 47 up to the age of 73 are eligible for screening.

What we’ve done is work out whether it would be possible to actually invite people based not only on age, but on their age and their genetic risk. In this way, some women at high risk would be invited for screening at ages younger than 47, whereas people at lower risk wouldn’t get invited until they were older than 47.

Using this approach, it would be possible to reduce the total number of women screened but still detect the same number of cancers. And so the efficiency of the programme would improve.

Effectively, what we’re doing is personalising the screening programme, so rather than a one-size-fits-all approach to screening, we would personalise the screening based on genetic risk.

The determination of your genetic risk is not something that is currently available – our model is a theoretical model. But, in essence, it’s straightforward. A blood sample or a mouth swab sample could be taken from a woman, say at aged 30 or 35, and a very simple genetic test done to establish their genetic risk for breast cancer.”

The opening of three new radiotherapy centres in England this month means that more patients will have access to cutting edge cancer treatments.

The latest equipment and technology will be put into action at Peterborough City Hospital’s radiotherapy unit, the Royal Berkshire NHS Foundation Trust’s Bracknell centre, and at the Christie in Manchester, which is expanding its radiotherapy services with a new unit in Salford this July.

Hilary Tovey, policy manager at Cancer Research UK, tells us what benefits these new centres will bring to patients.

“The advantages of these centres is that not only will more radiotherapy be available to people – and that’s really important because we know that half of all people with cancer should be getting radiotherapy, but at the moment it’s more like 40 per cent who are really getting access to this treatment – but they’re also going to be equipped with the latest state-of-the-art treatments for radiotherapy, which is real progress.

Radiotherapy is a really important treatment for cancer. In 40 per cent of cases where cancer is cured, it’s thanks to the radiotherapy that that cancer has been so successfully treated. And we know that radiotherapy is more effective in terms of curing cancer than cancer drugs, for example.

But we also know that not enough people are getting access to radiotherapy at the moment, and they particularly aren’t getting access to these latest treatments in radiotherapy such as intensity modulated radiotherapy and image-guided radiotherapy. These new centres are hopefully going to be equipped to overcome that.

Cancer Research UK is running a campaign at the moment called Voice for Radiotherapy. We’ve had over 13,000 people sign up to the campaign so far, and what we’re doing is asking the government to create more of a focus on radiotherapy. We want to see an action plan from government on radiotherapy and how we can build these services up to world class.”

Everyone can get involved and we’re really keen that we have as many signatories to the petition as possible. You can sign up and become a voice for radiotherapy by going to Cancercampaigns.org.uk and adding your voice.

A report published this month shows how future cuts by the government could undermine research funded by charities, leaving them no choice but to make difficult decisions about which studies they fund.

The Office of Health Economics report, commissioned by Cancer Research UK, also reveals how cuts would not only have an immediate effect, but could also seriously hamper research in the future.

Emma Greenwood, a policy researcher from Cancer Research UK, tells us more.

“Cancer Research UK receives no funding for its research from the government, but obviously the research projects that we fund are within the broader research environment in the UK. So we fund research in universities, in the NHS, and that research environment is very much supported by government funding.

A reduction in funding for research from the government could have a really damaging impact on science in the UK. Cancer Research UK very strongly want to encourage the government to continue to build the valuable relationship between charity and public sector funders of research so that we are really maximising our strengths as different research funders, and making sure that we can help save more lives in the future."

A £20 blood test for women suspected of having ovarian cancer is believed to be part of new guidelines from NICE to improve survival rates for the disease.

Ovarian cancer, often dubbed the “silent killer” because the symptoms are difficult to spot, is the fifth most common cancer in women.

Our reporter Simon Shears finds out what’s being done to improve the detection of this type of cancer.

Simon: Recent NICE guidelines aim to improve ovarian cancer survival rates by diagnosing the cancer earlier. Cancer Research UK’s policy manager, Emily Arkell, told me more about the guidelines

Emily: “The new guidelines will enable GPs and other health professionals to offer blood tests to women with possible symptoms of ovarian cancer. We think this is really good news because women with ovarian cancer tend to be diagnosed at an advanced stage, when it might have spread to other parts of the body.

Ovarian cancer is often referred to as the “silent killer” because symptoms are vague and can be confused with other conditions such as irritable bowel syndrome. Diagnosing ovarian cancer at an earlier stage will hopefully lead to rapid referral to gynaecological doctors, and hopefully improve treatment options. This should lead to improvements in survival for women diagnosed with ovarian cancer.”

Simon: But what does this blood test actually mean, and what is it looking for? To find out, I spoke to our ovarian cancer expert Professor Jonathan Ledermann, at University College London.

Professor Ledermann: “The blood test that’s now being offered within the context of primary care is a test for as protein in the blood called CA-125 (cancer antigen 125). This is a substance that is found in the majority of women with advanced ovarian cancer."

Simon: But, as he told me, this test is only part of the answer to diagnosing ovarian cancer early.

Professor Ledermann:  "It’s not a test that’s completely specific to ovarian cancer. It can be raised in a number of other conditions, and importantly it’s not particularly sensitive for all early ovarian cancers.

And although GPs are encouraged to do this test if women come to them with a number of symptoms that might be related to ovarian cancer, there is a danger that if the test is normal, then both the GP and the woman might be falsely reassured and that an early ovarian cancer may be missed.”

This month golf legend Seve Ballesteros sadly died at the age of 54 from a brain tumour, after losing what he described as “the toughest match of his life”.

Cancer Research UK was honoured to join forces with the Seve Ballesteros Foundation in 2009 and his experience brought a much needed spotlight onto brain tumours.

So far the partnership has already raised over £700,000 towards vital research that will help improve diagnosis and treatment of brain tumours in the future.

We spoke to Dr Steven Pollard, a leading Cancer Research UK brain tumour specialist based at University College London, to find out about the latest developments in research.

“One of the main obstacles is of course the nature of the organ we’re dealing with. The brain is essential – probably the most vital organ that we have – and tumours that arise in that organ can be a bit inaccessible.

They occur deep in the brain within our skulls, so to monitor what’s going on and to monitor the development of the disease can be quite challenging, because you don’t have an opportunity to monitor the cells. So that’s one of the challenges with brain cancer.

The other challenge – thankfully in a way – is that it’s not one of the major forms of cancer in terms of the number of patients that come through. So that can be a challenge in terms of getting the number of samples you need. So if fewer people have the disease, there’s less opportunity to study it.

So you really need a close interaction between the scientists and the clinicians. That’s one of the things we try and achieve here, to have the basic biology and basic scientists close by to the clinical centres to get samples and interact.

I guess finally, one of the obstacles has been the funding. Brain tumour research hasn’t attracted the same attention as other forms of cancer over the years. So the work and funding from Cancer Research UK, Samantha Dickson and other charities is incredible important to support this research.”

One of the areas you specialise in is looking at stem cells. What are stem cells and what role do they play in brain cancer?

"My research is really focusing on stem cell biology – I’m a basic biologist. Stem cells are really special types of cells – the immature cells that are the building blocks of our tissues and organs both through development and in the adult body. They’re replacing the tissues that are lost in our bodies through injury or disease.

So they’re really long-lived cells that have this capacity to grow and proliferate. But the features that are common to many cancers are features shared with stem cells – this ability to grow forever, this immortality if you like. So the idea of cancer and stem cells being flip sides of the same coin is really an old idea. This has implications clinically because what you really need to do is target these stem cells.

It’s a bit like a weed in the garden – if you cut down the weed but don’t pull out the root, then of course the weeds springs back. So you could almost view a tumour as a stem cell “gone wrong”, and there’s good evidence in some tumours that the cancers may arise from the stem cells being mutated or defective."

And what progress have we made with brain cancer so far?

"There’s two extremes. In childhood medulloblastoma there’s been good progress in terms of treatment. Children survive a lot longer now, and are cured in many cases through improvements in treatment. Of course there are many issues with the treatment of childhood cancers, with side effects and damage to the brain during the treatment process, which can be quite debilitating.

The other side is the primary brain tumours that occur in adults – glioblastoma is the most common form – and there it’s been a lot more disappointing. There’s very few treatments that cure the patient or even give long term survival. One of the few is temozolomide, that came along some years ago from work funded by Cancer Research UK. That does seem to help a subgroup of patients with glioblastoma and can help them live longer.

But really I would say that it’s still very disappointing in terms of what’s available, and we’re really going to have to find drugs and chemotherapy or radiotherapy that somehow targets these cells and maybe specifically targets cancer stem cell populations."

Are there any areas where you think we might see some new progress?

"Like other areas of cancer biology there’s really been a revolution in terms of our understanding of the disease, particularly in terms of the genes that are defective in cancer. A lot of this work has emerged from the Human Genome Project, so the technological improvements are vast.

We can now define very accurately the spectrum of gene defects in brain tumour, and get a full catalogue of the events that have gone on in the tumour. So there’s a great deal of knowledge about the genetic particularly of glioblastoma. This was one of the first types of cancer to go through the international effort to sequence the genomes of a range of cancer types.

This is really immediately paying off as a fantastic tool for biologists to study the pathways and things that go wrong. Of course it’s also showing us that glioblastoma isn’t one type of disease – it seems as though there’s at least three or four subgroups. We begin to define the pathways that have gone wrong, and for many of those there are drugs available or being developed that we could test.

I guess one of the challenges is that these tumours cells have mutations at various different levels and in different pathways. There’s multiple things that have gone wrong and we’re going to have to use a combination of drugs. So there’s promise in terms of understanding the disease, but as always, how we translate that into benefits for patients is going to be a challenge.

Getting the number of patients through clinical trials where we can really test these different drugs and drug combinations effectively is going to be a great challenge, and we need collaboration across laboratories and clinical centres.”

To make a donation to the Seve Ballasteros Foundation, please visit seveballesterosfoundation.org.uk

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