October 2008 podcast transcript

00:00

Kat: Hello, I'm Dr Kat Arney, and this month's podcast is all about breast cancer. We'll be finding out how some of our scientists are working to improve treatment for the disease, and get the low-down on breast awareness - what's the best way to check yourself?

Coming up later, we hear one scientist's vision for breast cancer treatment in the future, but first, here's the news with Lara Bennett.

00:56

Lara: A new study funded by Cancer Research UK has revealed that computers could help to read mammograms, potentially freeing up time and resources for the stretched NHS breast screening programme.

The trial, called CADET 2, recruited 28,000 women in three towns - Manchester, Coventry and Nottingham - who were taking part in routine breast screening. Their mammograms were read by two radiologists as is usual, and also by one radiologist and a computer aided detection system known as CAD.

The researchers found that a single expert and CAD were just as effective at picking up cancers as two doctors. If it is adopted by the NHS, CAD could free up valuable time for radiologists, helping them to keep up with three-yearly breast screening. In some areas, the programme is under so much pressure that women are not screened as often as they should be.

Professor Stephen Duffy, one of the lead researchers on the study, explains how CAD works, and how expensive it is.

"It's relatively expensive, but not as expensive as training a consultant radiologist! Once you've got it, it's not that expensive to maintain and keep.

How it works is the mammogram is scanned in to the computer and then appears on a screen. The computer aided detection system puts little marks on the screen where it thinks there might be an abnormality in the breast - not necessarily cancer but something that need further investigation just in case it is cancer.

Now the computer-aided system is quite sensitive but not very specific. What that means is it overcalls - it finds lots of potential abnormalities where there's nothing wrong. So the human reader has to over-rule the computer quite a lot of the time. But sometimes the computer picks up something that the human reader has overlooked, so the human reader says "Gosh, we'd better get this lady back and have a look.""

The latest statistics show that although long-term breast cancer survival is increasing in the UK, there is a worrying gap in survival between rich and poor.

Cancer Research UK's Professor Michel Coleman and his team analysed data from more than 380,000 women who were diagnosed with breast cancer in England and Wales between 1986 and 1999. They found that after just one year, survival rates were higher among the richest women compared with the poorest, and this gap doubled five years after diagnosis.

It's not clear what is responsible, although researchers suggest that delays in going to the doctor, low uptake of screening, and problems with access to treatment may all be factors. Poorer people may also be more likely to suffer from other diseases that affect cancer treatment and survival.

The recently launched National Cancer Intelligence Network will be gathering information to help researchers understand more about the gap between rich and poor, and point to ways to narrow it.

And finally, Cancer Research UK has announced another record-breaking spen on research for the financial year 2007-2008. The charity spent an impressive £333 million on research into all aspects of cancer, covering treatment, prevention, screening, diagnosis, fundamental cell biology and quality of life research, funding the work of more than 4,500 scientists, doctors and nurses. This is a 6% increase on last year.

A further £11 million was spent on providing cancer information and advocacy.

Kat: And if you want find out more about these stories, or get the latest from the charity's scientists, and researchers around the world, then have a look at our News & Resources website.

04:45

Kat: Breast cancer is the most common cancer in the UK, and the latest figures show that over 45,500 women a year are diagnosed with the disease. The good news is that there are more than half a million women alive today who are surviving breast cancer, but almost 12 and a half thousand women still lose their lives to the disease every year.

Cancer Research UK is the major funder of breast cancer research in the UK, spending around £45 million last year. This covers all aspects of research into the disease, from prevention to diagnosis, better treatments and improving the quality of life for women living with breast cancer.

Many breast cancers are discovered by women themselves, but what's the best way to check yourself? Here's Becky Partridge, one of Cancer Research UK's cancer information nurses, to give us the low-down on what to look for.

"Most importantly it's any change they notice in their breast. A change in shape, or how they feel - a lump of something - or a change in the nipple or the skin, if there's a rash or thickening in the breast. Something that's different for them. It's not always a lump - if there's a rash on the breast, or any discharge from the nipple, or change in the size of the breast, that's something to be aware of.

After a period is the best time to check your breasts, but there isn't one particular way. If you're most comfortable doing it lying down that's fine, if you want to do it in the shower that's fine too. Doing it every month around the same time in the menstrual cycle should be fine. If you do find a lump, the best thing to do is go and see your doctor.

It's very frightening whenever we have something wrong with our bodies, but we must bear in mind that most breast cancers are in women over fifty, and many women, especially younger women, have lumps that aren't breast cancer. Many lumps are benign [not cancerous] - fatty lumps and cysts are common in younger women. So if a woman finds a lump then yes, she should go to her doctor, but the message is not to be too alarmed.

Older women should make sure they go for the NHS breast screening programme, which invites all women from the age of 50 every three years to go for a mammogram. So if you get that invitation then make sure you go along."

07:54

Kat: Women are invited to come for screening from the age of 50 until 70, but women over 70 can always phone up to ask for an appointment at their local screening centre.

One woman who noticed a problem lump in her breast was Sharyn Clarkson from Redcar. I called up Sharyn for a chat to discover her story, and find out how she’s now raising money for Cancer Research UK's breast cancer research.

"I was in the shower and I found a lump in my breast. I was in my period so I waited until that had finished, and it came back afterwards. I went to my GP and he couldn't find it, but he referred me to my local hospital and I had a mammogram and they said "Yes, there's a lump there".

I had a lumpectomy followed by 6 months of chemotherapy, and then 6 weeks of radiotherapy. I was on tamoxifen for 5 years, came off the tamoxifen and then four years later woke up one morning and said to my husband "I think I need to see the breast cancer nurse". I had no symptoms at all, no changes in my breast, but I knew in my head.

I called up the breast care nurse and they fitted me in for a mammogram and I found out I had a new tumour. I opted to have a double mastectomy, which was 5 years ago yesterday. And I've just finished 5 years of tamoxifen again.

I'm planning my fourth Pink Dip to raise money for Cancer Research UK. We all get dressed up in pink and go into the North Sea. Hopefully we'll get over 100 people this year. It's quite cold sometimes! The first year I did it, it was beautiful but the sea has got colder. Last year we did it the last Saturday in October, but this year we’re doing the first Saturday, so I’m hoping 2-3 weeks might make all the difference!"

10:11

Kat: As we heard from Sharyn, tamoxifen can only be taken for five years, and sometimes the cancer can come back afterwards. This happens because the cancer cells become resistant to the treatment, and start to grow again.

Professor Helen Hurst heads the Transcription Laboratory at Queen Mary, University of London. She and her team are carrying out highly detailed investigations of some of the genes involved in breast cancer, studying how they are switched on and off, to help us understand why tamoxifen sometimes stops working.

I started by asking her what first got her interested in breast cancer research.

"I guess that's always been an interest of mine from the time my grandmother died of breast cancer. The fact that the genes we were looking at at the time were expressed in breast cancer almost made a life-long interest come into an actual practical reason to follow it in my own research.

We're currently looking at differences between tumour cells that respond to the anti-oestrogen drug tamoxifen, which most people have heard of - it’s a very effective drug for the treatment of breast cancer. Unfortunately, despite it being an excellent drug, many patients develop resistance to the drug, and it's vitally important to understand why that happens, and how we can stop it, because then we can prolong the clinical usefulness of this very well-tolerated, easily given and cheap drug.

So we're currently looking at some tumour samples we've obtained from patients which have clearly either responded to tamoxifen or developed resistance to tamoxifen. And by using something called DNA chip technology we can look at all the genes that are expressed in these two sets of samples, and the differences between them. Hopefully we can draw some conclusions about the different cellular pathways that are being used in both the responsive and the non-responsive tumour.

We would hope that this will pave the way for new treatments for cancer. There's around 30,000 genes in each human cell, which is a little hard to get your head around, even with the help of a computer. But what we're trying to do is look for patterns of genes that are involved in particular cellular pathways.

And if you can look at the pathways that are activated, there are often already known activators or inhibitors of those pathways already in clinical medicine, perhaps being applied in other fields, which could then also be given alongside tamoxifen to help suppress a pathway that contributes to resistance - so then you’d prolong the usefulness of tamoxifen as a drug.

In the future, everybody's hope is that there's much less of a lottery in terms of whether the treatment you receive will actually help you. At the moment, some people get very aggressive treatment, which perhaps they don't need because they would be cured with perhaps surgery and very mild treatment. Other people seem to have a benign form of the disease but unfortunately they relapse very quickly with advanced disease.

So the dream is to define the makeup of an individuals tumour much more precisely so as to much better tailor the therapy for that individual person. It sounds very expensive, and how could this ever happen on the NHS, but already some labs around the world are developing small DNA chips which will allow each patient's sample to be examined for whether they're up or down for various genes that are on the chip, and given a risk profile and a therapy profile.

These are still being tested as to their efficacy, but that is really where people think we should be going, particularly for a disease such as breast cancer, where there are so many forms of the disease."

Kat: If you want to find out more about any aspect of breast cancer, from signs and symptoms to treatments and the latest research, then have a look at our patient information website, CancerHelp UK.

And if you want to raise money for our vital research towards beating breast cancer, then there's loads of things you can do. Whether it's hosting a pink party, doing a sponsored walk or anything else you can imagine, find out how you can get involved at www.cancerresearchuk.org/breastcancer. You can also call our fundraising hotline on 08701 60 20 40.

15:42

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, so until then, goodbye!

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