November 2008 podcast transcript

00:00

Kat: In this month's podcast we're bringing you all the latest news and research progress from the NCRI Cancer Conference in Birmingham, the biggest of its kind in the UK.

Every October, thousands of people from the UK and around the world gather at the International Convention Centre in Birmingham for a very special event - the National Cancer Research Institute, or NCRI, Cancer Conference. Bringing together scientists, doctors, nurses, charities and patient groups, the conference is a showcase for the latest research into the disease.

00:55

For the past few years, the conference has started with a public talk, and this year was no exception. Cancer Research UK's Professor Michel Coleman gave a fascinating lecture about cancer statistics - yes I really did say that - explaining the true figures that underlie the perception of the UK as the "sick man of Europe" when it come to cancer survival. I asked him if I thought this portrayal was true.

"No I don't think Britain is the sick man of Europe - I think that's a nice headline for a newspaper, but it's too facile to tell us anything useful.

I do think that in the UK, or its four constituent countries that have different patterns of cancer, that the level of occurrence of these cancers has been higher than in some [other countries], so we need to improve prevention, such as reducing the amount of smoking. That will reduce a number of cancer such as lung and pancreas, and that's actually happened amongst men in the UK over the past twenty or thirty years.

I was asked to focus today particularly on patterns of survival, and how they have influenced cancer care in the UK. So I focused my remarks mainly on the so-called EuroCare studies, which - as the name suggests - are studies looking at the outcome of cancer across European countries.

The first one was published in 1995, and the most recent in 2007, a total of four such studies. The first study covered twelve countries, including England and Scotland, and the most recent covered 23 countries, including all four of the home nations. If you look at those studies in the round, survival from most of the major cancers has been lower in the four UK nations than the average for Europe.

But it's not true for all cancers. I thought it was important to point this out today, in response to questions from the audience, that it's not some devastating failure of the entire system or of data collection that has produced these figures like some sort or artefact.

No, if you look at Scotland for example, survival from melanoma is higher than the European average, and quite close to the highest in Europe, and if you look at cancer of the testis in men or Hodgkin's diseases, which is a common type of lymphoma that occurs in younger people of both sexes, the survival for those cancer is as good as, or better than the European average. And in some cases it's a lot better.

So that suggests to me that we're clearly capable of getting it right in this country, and we can achieve just as good results as anywhere else. Where we don't - where the survival for cancers in the UK have been lower even than the European average for some time, we have been catching up.

That's most obvious for breast cancer, which I focused on today because October is breast cancer awareness month. You can see that survival in the British nations has been not only improving but improving slightly faster than in comparable countries which we've often been unfavourably compared.

And that suggests that we have been doing things better than in the past. So I don't think we're the sick man of Europe. What we have been looking at is a National Health Service that has been under-funded and less well organised than it should be."

04:40

Kat: Another interesting, and somewhat controversial, talk that got a great deal of media coverage came from Cancer Research UK's Professor Valerie Beral, based at the University of Oxford. She's a leading expert on the risks and causes of breast cancer, so I asked her to explain more about what the major risks are.

"Really the main things that we've known about for centuries is that it's women's childbearing patterns - how many children women have, their age when they have them, and whether they breastfeed them or not. And if a women has many children starting at an early age, and breastfeeds them for quite a while, her risk of breast cancer is much reduced by a very large extent.

If women in this country had as many children as they do in developing countries - not that I'm suggesting that they do! - and breastfed them for s long, instead of one in 15 getting breast cancer by the time they were 70, it would be closer to one in 50 or so.

The link has been known about for centuries, but a little bit forgotten I think. It was known that nuns in Italy had 6-7 times as much breast cancer as other women in Italy. It's been known for a long time that single women have higher rates of breast cancer. Women with breast cancer have fewer children, even if they're married, than women who don't have breast cancer.

It's all been known about for centuries, but we got a bit waylaid. We though "Oh we know all that, let's get on to something else" but actually the point is that that's the main reason why women get breast cancer. All the other things are much more minor. We almost forget the things that we know, and try and discover something new and novel. Whereas it's the old-fashioned things that are really the most important.

It's almost taken for granted that this is so, so it's not a big topic of research why this should be, or what we could do about it - that's what I was saying today. Why don't we know more about why, and why don't we try to use that information for prevention. That, to my knowledge, is not happening very much.

We actually know - and this is from very thorough world-wide data from hundreds of thousands of women and comparison groups - that a pregnancy isn't protective, it's got to be a birth. A pregnancy that ends as a miscarriage or abortion, that only lasts for a few months, does not protect against breast cancer. The pregnancy has to go on to the end.

So that's a clue that we should be using to try and understand what's going on. Pregnancy lasts nine months and it gives you lifelong protection against breast cancer, we really should be finding out what it is. It must be some of the hormones that are doing this, that are making the breasts change. We should be really trying to do this, to develop a treatment that could be given over a few months at a young age that would give lifelong protection.

08:06

Kat: Many researchers use the conference as an opportunity to present exciting new findings. Professor Nazneen Rahman from the Institute of Cancer Research in Surrey, revealed her new discovery into the causes of Wilms Tumour, a type of kidney cancer that affects children.

I asked her to explain more about her results, and what they might mean for children with this disease and their families.

"The new thing that we've found isn't actually a gene per se. What it is that we've shown is that defects in certain growth factors can be a cause of Wilms' tumour. In children obviously growth is under quite tight control. From conception onwards the baby has to grow and then slowly growth has to be suppressed so that you don't grow forever. So there's quite tight control both promoting and suppressing growth.

What we've known from some rare genetic syndromes is that sometimes if that growth control goes wrong, you've got too much growth, that can also be associated with tumours in childhood, particularly Wilms' tumour. So what we did is to look at whether that could be the case for children who are otherwise well, who don't have a genetic syndrome, but just have Wilms' tumour.

So we were looking at these growth factors and we found that there were defects in those growth factors in around five per cent overall of children with Wilms' tumour, and about three per cent don't have any other features - they don't have a genetic syndrome, they've just got Wilms' tumour.

Occasionally those things can also be inherited, so that has implications for the family generally. I think the importance of the work was partly finding out one of the causes of Wilms' tumour. That can be very helpful for families, if they know why a child has got Wilms' tumour.

Also, we know that if you have these growth defects you're more at risk of having your second kidney affected. That's very important for treating the child, so that we can make sure it's treated properly but we don't take all of the kidneys out, so they still have some kidney function.

For the families, where it's relevant, it means that we can see if anybody else might be at risk and potentially give them screening to pick up a Wilms' tumour early, if that's appropriate.

One of the things that we were doing was in terms of the defects that we found, they are quite complicated. There's a lot of different ways in which these growth factors can be affected.

So we helped to develop a test that does exactly that - a single experiment that can take place on one sample in a day to see whether these growth defects are present. That's already been taken up by the NHS. So for children with Wilms' tumour, this test is now available where appropriate, and can be done already.

Generally Wilms' tumour is very treatable, so that's great, but if you've got both kidneys affected, it can be difficult. You want to make sure that you can treat the Wilms' tumour but also retain enough kidney to preserve kidney function.

So in those cases it's useful to know whether or not somebody might be at risk of having Wilms's tumour affecting both kidneys, so you can ensure that you're keeping a careful eye on that other kidney in case any other trouble from Wilms' tumour occurs. But also you can manage it appropriately, so that's really where I think it's going to be very helpful."

11:47

Kat: One of the most popular sessions at the conference was about the cost of cancer care, including a talk from Professor Mike Richards, National Cancer Director for England, who outlined several ways in which he thought that money could be saved and redirected within the NHS. I started by asking him where we stand now in terms of health service spending on cancer.

"We know a lot more about the costs of cancer care than we did a few years ago. We know overall that we spend about 5 per cent of the NHS budget on cancer care, in total we spend around four and a half billion pounds every year on it.

And we now know a lot more about how that is distributed among inpatient care, treatment with drugs, treatment with surgery, treatment with radiotherapy, screening - all those different elements. The largest single element of that is inpatient care - people coming into hospital and staying in hospital. Sometimes coming into hospital because they are unwell, but not because they need an operation for example.

We've done a lot of work looking with people from other countries about how we are using our inpatient beds, and how they would use them in their own countries. And it's quite clear that we could be more efficient, and that would be good for patients, and for the NHS. Patients don't want to spend longer than they need to in hospital, and from an NHS point of view it costs a lot of money.

I believe we can streamline the processes of care for people who need to come into hospitals. In some cases we need to be able to avoid them needing to stay in hospital by having good day case facilities. If we can do that, our estimate is that across the country we could probably save as much as £350 million a year.

New techniques like keyhole surgery and enhanced recovery could also make an impact. We've already seen a significant change over the years. When I first became a consultant, a woman having breast surgery would probably be in hospital for ten days, then it went down to five days. And now in a lot of places it would either be done as a day case procedure, or perhaps one overnight stay. So we've seen a great deal of change in that area.

I think that one of the other areas is keyhole surgery, and robotic surgery as well, which can enable patients to recover more quickly. Again, that's good for patients, getting them home and up and moving more quickly, but it's also good for the NHS.

Our spend on cancer is broadly in line with some other countries, but we know that it's a bit below the amount that's spent in either France or Germany. But we don't have enough cross-national studies at the moment, and it would be very useful to have more information on spend in different countries - not only what the total spend is, but how they're spending it. What proportion is being spent on people in hospital, what proportion is being spent on drugs and things like that. And we are working on those things at the moment.

Freeing up more money from the NHS budget would make an impact. We need to constantly be looking at how we're using the money, and using it to best effect. This is taxpayers' money, we need to use it wisely, we need to get the maximum benefit for patients from this money.

Obviously we would all want to see more money being put into prevention and screening programmes, which are highly cost effective, but we also need to be able to put more money into radiotherapy facilities and good new drugs. We can do that, I believe, if we really look across the board at using the whole budget most equitably and efficiently.

15:49

Kat: If you want to find out more about some of the speakers and the talks from the conference, then have a look at our Science Update blog. My colleagues and I have been writing reports from some of the most interesting sessions, and you can find links to longer interviews with some of the world's leading cancer researchers.

We've reached the end once more so we hope you've enjoyed the podcast. Don't forget that your feedback is vital in helping us improve the show, so please send us your comments and suggestions by email to podcast@cancer.org.uk.

We'll be back next month with all the latest news from Cancer Research UK, and we'll be finding out how simple organisms like yeast can provide new clues to cancer, so until then, goodbye!

• Credits:
• Presented and produced by Kat Arney
• Original music written and performed by Kat Arney and Henry Scowcroft
• With special thanks to all the participants