Every news story about cancer research should come with a health warning: believe the hope, but not the hype. Good headlines are quick and catchy, good science is steady steps taken on a complicated issue over a long time. If a new treatment is still being researched, it could be metaphorical miles and actual years away from getting into the hands or bodies of patients. As blogger Kay Curtin, who has advanced melanoma, puts it: “The media tend to pick one line on a report and run with it, but they do not draw attention or highlight that it’s just a potential benefit, or the fact that many of these are just proven in a petri dish or a mouse and very often do not prove effective when tested on humans. It is cruel to existing patients to make claims with misleading headlines.”

One of the best ways to deal with cancer is to divide and conquer, based on as much knowledge as we can get of how individual tumours work. Treating all cancers from the same part of the body equally isn’t good enough – you must match the right patient with the right treatment.

As Dr Justine Alford, senior science information officer at Cancer Research UK, explains: “As science continues to reveal more about cancer, we’re starting to think of it in a different way, as we know that two tumours affecting the same part of the body won’t necessarily behave in the same way. Some will be more aggressive; some might be resistant to one treatment, but respond to another. Our understanding of these unique features of different tumours has helped to produce one of the most exciting areas of research for all cancer types: personalised medicine.”

Prostate cancer, according to Dr Robert O’Connor, head of research at the Irish Cancer Society, has in recent years “seen the greatest revolution in terms of new agents”. One huge step forward was the use of radiation to reduce the impact of prostate cancer that spreads to bones. Another was the development of better diagnostics, including PSA tests, which mean that most men are diagnosed while their prostate cancer is still curable. The jury is still out on the ideal timing of treatments, but researchers at the University of Birmingham found this summer that giving a drug earlier saved more lives.

Eight out of 10 women now survive breast cancer, but research won’t be over until no one dies and survivors have a far easier journey. Researchers are trying to find out more about how we might prevent breast cancers, how some become resistant to therapy and how to stop them from spreading.

With the number of cancer survivors in the UK expected to increase by 1 million each decade, “survivorship” – how to live as comfortably as possible with and after cancer – is an important area of research for all cancers.

Lung cancer, however, remains deadly. There are often no symptoms until it has taken over a large part of the lungs or spread to other parts of the body. On top of this, it grows quickly and is sometimes intrinsically resistant to chemotherapy. Other cancers that don’t come with clear early warnings include pancreatic cancer – the Pancreatic Cancer Research Fund says it is“the only cancer that has seen no improvement in [survival rate] over the last 40 years” – and oesophageal cancer, which is on the rise, partly due to obesity and alcohol use. Pancreatic and brain tumours are hard to get drugs into. The brain is surrounded by a very selective gatekeeper called the blood-brain barrier, which normally keeps possible poisons out; while as much as 90% of pancreatic tumours comprises of a dense tissue called stroma, which surrounds the tumour like a shield.

Researchers are looking for kinder, more effective treatments for these cancers, as well as ways to catch them sooner. Innovative ways to get drugs into brain tumours, such as modifying bee venom or adjusting the chemistry of nanoparticles, offers hope. Lung cancer research, much of it at the University of Manchester and UCL, is carving out a better understanding of how the cancer works and how we can treat it better. Meanwhile, both pancreatic and oesophageal cancers had breakthrough discoveries this year when subtypes of each cancer were discovered, meaning they can both potentially be treated with personalised medicine in the future.

Of course, if we already knew the answer, it wouldn’t be research. The greatest challenge, always, is the complex and wily nature of cancer, but there’s no getting away from the fact that finite funds aren’t evenly spread across different cancer types. More people donate towards breast than lung cancer research, partly reflecting the number of people affected by breast cancer and the well-organised advocacy behind it. And according O’Connor, in Ireland, of the tens of thousands of cancers diagnosed every year, less than 200 are in children. However, because childhood cancer is so emotive, many more donations come in for paediatric than geriatric cancers.

In a recent video on Twitter, the charity Breast Cancer Now said that every £25 raised supports one hour of research. It’s impossible to guess at how many more hours will be needed before we can live free of the fear of cancer. The only certainty is that we won’t give up.

https://www.theguardian.com/science/2017/aug/14/cancer-treatment-sorting-the-good-news-from-the-hype

A drug that can extend the lives of women with advanced breast cancer has been approved for routine use on the NHS.

Charities and campaigners reacted with huge disappointment when the National Institute for Health and Care Excellence (Nice) rejected the drug, Kadcyla, on cost grounds in 2016.

But a deal has now been struck between NHS England and the manufacturer Roche, backed by Nice, to make the drug available to around 1,200 women a year in England. Until now, the drug has been funded only through the cancer drugs fund.

In clinical trials, Kadcyla, which has a full list price of £90,000 a year per patient, was shown to extend the lives of people with terminal cancer by an average of six months. It also dramatically improves quality of life, compared with other treatments, and reduces side effects.

Details of the price agreed between Roche and the NHS are being kept confidential.

Kadycla is for people with Her2+ breast cancer that has spread to other parts of the body and cannot be removed through surgery. Previous treatments, usually Herceptin, must have failed for patients to receive the drug.

Kadcyla, also called T-DM1, combines Herceptin with a potent chemotherapy agent. It works by attaching itself to the Her2 receptor on cancer cells, blocking signals that encourage the cancer to grow and spread. The chemotherapy element also goes inside the cell and causes it to die from within.

Kadcyla is given intravenously once every three weeks.

The chief executive of NHS England, Simon Stevens, speaking at the NHS Confederation conference in Liverpool, said: “NHS cancer survival rates are now at record highs, and this year we’re going to be making major upgrades to modern radiotherapy treatments in every part of England.

“NHS England is also taking practical action to drive greater value from taxpayers’ growing investment in modern drug treatments, and that work is beginning to bear fruit.

“In this case, tough negotiation and flexibility between the NHS and Roche means both patients and taxpayers are getting a good deal.”

Richard Erwin, general manager at Roche, said: “This is a positive example of how solutions can be reached when all parties show flexibility.”

Delyth Morgan, chief executive of the research charity Breast Cancer Now, said: “We are absolutely delighted that tough negotiation and flexibility by Nice and NHS England, and the willingness of Roche to compromise on price, have ensured that thousands of women with incurable breast cancer will be given precious time to live.

“We want to congratulate and thank the hundreds of thousands of women, men and families across the country for their relentless campaigning to ensure this crucial lifeline drug is routinely available to those that need it. 

“However, this news comes at a time when there is a real possibility that Perjeta, the first-line treatment for this group of patients, could soon be removed from NHS use, with a decision imminent.

“Perjeta’s benefits are extraordinary, offering nearly 16 additional months of life to women with incurable breast cancer, and it is imperative that a solution is found to save this drug, at a cost affordable to both the NHS and the taxpayer.”

Prof Carole Longson, director of the centre for health technology evaluation at Nice, said: “The committee acknowledged the comments received from patients during the consultation on the draft recommendations for trastuzumab emtansine [the generic name for Kadcyla], in particular that 115,000 people had signed a Breast Cancer Now petition urging Nice and the company to ensure that it remains available.

“We are therefore very pleased that the company and NHS England have been able to agree a deal that will achieve this.”

https://www.theguardian.com/society/2017/jun/15/breast-cancer-drug-kadcyla-approved-for-nhs-use

Nearly 900 women in the UK are diagnosed with breast cancer each week. Yet according to a new report from Avon, a third of 2,000 British women surveyed never examine their breasts. Avon's Breast Promise campaign has teamed up with a psychologist to come up with tips to encourage women to regularly check their breasts. Daughters should be taught to check their breasts from 12 or 13 years of age, and be told it is as important as caring for their skin or hair. You should tell your family you will be checking your own breasts once a month, and set an automatic alarm on your phone to remind you.

Or should you? Is examining your breasts useful?

The solution

There has never even been agreement on the right way for women to examine their breasts. A large study in Shanghai of 266,064 women aged between 30 and 64 years of age found that those given breast self-examination instructions had the same numbers of cancers detected, and no reduction in the number of deaths. Women who examined their breasts had more biopsies for harmless lumps, which can cause scarring of the breast.

What may be more useful is encouraging women to be aware of what their breasts look and feel like normally, rather than getting them to do a thorough regular examination. Being "breast aware" is preferred to self-examination by Cancer Research UK. This means looking out for changes in the nipple (a pulling inwards, bleeding or rashes), puckering of the skin, a lump or thickening that feels different, any change in the shape of the breast, how it hangs or if one breast becomes larger. Most cancers are found by women themselves (screening by mammography only finds one third to a half of breast cancers), the majority of whom don't practise self-examination but are aware of changes in their breasts.

It's not clear from their report if Avon is suggesting women should self-examine or become breast aware. The report focuses on getting women into a habit of checking breasts. But they do seem to advocate monthly checks for which there is no evidence. As the authors of a paper in the European Journal of Cancer wrote, breast cancer support organisations should recognise their responsibilities. "Intense promotional activity such as breast cancer awareness month every October results in dismayed clinicians finding their clinics overcrowded with the worried well to the detriment of patients with breast cancer."

https://www.theguardian.com/lifeandstyle/2012/sep/30/breast-cancer-examine-myself-lumps

Many of us will know someone who had breast cancer found at screening. The cancer seen on a mammogram may have been microscopic, so early in its malignant life that it hadn’t broken through the wall of its milk duct. Thank heavens, then, for breast screening, which is offered to all women between 50 and 70 in the UK and other countries. It is promoted enthusiastically as lifesaving, but does it deliver on its promise? And are the randomised controlled trials that persuaded governments to offer it, carried out in the 1970s and 80s, still valid?

The solution

Yes, but mostly no, seems to be the answer. Screening for cancer only works if it reduces deaths from cancer. It does this by reducing the number of the advanced cancers that are more likely to kill people. What screening doesn’t want to do is just identify breast cancers earlier (so someone has the diagnosis for longer) or find breast cancers that wouldn’t have caused any trouble in that person’s lifetime. A study of Dutch women in the BMJconcludes that rates of more advanced breast cancers didn’t fall between 1989 (when screening started) and 2012, and that while more women survived for longer, about 28% of that was due to better treatment and only 5% or less due to screening. Supporting this finding was the fact that women under 50 who weren’t eligible for screening had a similar fall in death rates over the same period.

The researchers found that more than half the cancers identified by screening would never otherwise have been found or caused problems. These women had breast surgery and anxiety that they didn’t need. The researchers pointed out that Dutch and Belgian cancer deaths both fell by 34% in the same period – although the Belgians did not start their screening programme until 15 years later.

The Welsh NHS breast screening advice says that screening reduces your risk of dying from breast cancer by 35%. But it is more meaningful to look at how many women would need to be screened to prevent deaths from breast cancer. Michael Baum, a professor emeritus of surgery at University College London, estimated that 10,000 women would need to be screened to prevent three to four deaths and that this would lead to 120-140 women being overdiagnosed and having unnecessary treatment. In an editorial accompanying the Dutch research, Mette Kalager, an associate professor from Harvard, writes: “The good news is that breast cancer-related mortality is falling. The bad news is that screening mammograms are unlikely to be responsible for that benefit while causing well-documented harm.” So far, I have not had screening, but it’s an individual choice and hard to resist.

https://www.theguardian.com/lifeandstyle/2017/dec/11/breast-screening-worth-having-cancer

Cancer news usually involves unremittingly grim stories about carcinogens or rising cancer rates. But recently there was something more positive. A Cancer Research UK report shows that deaths are "set to fall dramatically" by 2030. The 17% drop will be the result of major improvements in diagnosis, treatment and fewer people smoking. Many more of us can expect to survive cancer.

This is marvellous news but unfortunately it's not the full story. "It is not that a magic wand has been waved and they are all cured," says Ciarán Devane, chief executive of Macmillan Cancer Support. "It actually means many people will be living longer with the disease. The impact of cancer does not suddenly stop when treatment is over. Many cancer patients have to deal with the physical and emotional effects of their cancer for years afterwards."

This is a common reaction. "Rates of depression and anxiety are very high when treatment ends," says Dr Michelle Kohn, director of Living Well, a programme that offers emotional and practical support to cancer patients at Leaders in Oncology Care, a private London-based clinic. "Other emotional issues, such as low self-esteem, anger, stress or sleep problems are also widespread."

On top of this, cancer survivors are often battling with physical and practical challenges, anything from huge financial losses, to the side effects of medication, profound fatigue, a confused-feeling known as "chemo brain", or lymphoedima (swelling). Their loved ones, meanwhile, might be increasingly baffled as to why they can't bounce back and make the most of life. "People suffer for years, often in silence, without any real support," says Kohn. "Life after cancer can actually be very difficult and lonely."

It does not help, says Devane, that, "the current system is woefully inadequate at supporting the changing nature of cancer survivors". In the United States, most major cancer units have survivorship programmes where teams of psychologists, nurses, and other specialists offer ongoing information, advice and emotional support to patients when treatment ends. This, of course, is funded by health insurance. In contrast, NHS post-treatment psychological or practical services are limited, to say the least.

The National Cancer Survivorship Initiative (NCSI), a partnership between the Department of Health and Macmillan, was launched in 2008 to help improve the situation but it has a massive job on its hands. According to NCSI research, 60% of cancer survivors have unmet physical or psychological needs; over 33% have problems with close relationships, careers, or have difficulty performing household duties; over 90% have suffered financial losses. Waving these people off with a six-month followup appointment, is simply not working.

The NCSI is launching a range of programmes that take a more holistic approach to the needs of cancer survivors, for example encouraging physical activity, or helping with issues including work and finance. "It is essential the NHS now implements these solutions," says Devane. But there is a very long way to go.

Other cancer charities, in smaller ways, are also trying to plug the gaping hole in post-cancer care. The charity Maggie's runs a free six-week programme called "Where Now?" that aims to help people adjust to life after treatment ends.

There are, in fact, many highly effective ways to cope with tricky post-treatment issues. But without expert guidance, few people know where to begin. "The fear that cancer will come back again is huge for me," says Christina. "It's impossible to ignore. There are reminders everywhere, on TV, the newspaper, the internet. Other people also say things without realising the impact they're having – more than once I've had people tell me about someone they know whose cancer came back, spread and killed them."

In fact, Christina's cancer has already returned, twice. And she has also had to contend with complications from breast reconstructions (so far she has had four reconstructive surgeries). She is now cancer-free and "determined to enjoy life to the full". But still, whenever she feels unwell the fear sets in and – despite a supportive family – she says that she can feel very alone.

"My GP is brilliant," she explains, "But there's only so much she can do. The consultants are absolutely inundated, and understandably, since I don't have cancer, I can't be their top priority. But I also know that all three times my cancer was dismissed at first by doctors, so it can be terrifying, if I feel an unusual symptom, to be told to wait and see."

None of this must dampen the brilliant news about falling death rates. But there is a clear message behind the headlines, and one that must not be ignored: NHS post-cancer treatment services need to change dramatically.

• Frances Goodhart, of The Cancer Survivor's Companion: Practical ways to cope with your feelings after cancer (Piatkus).

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https://www.theguardian.com/lifeandstyle/2012/oct/07/life-after-cancer