Department of Health and Social Care | May 2018 |Government announces £40 million for brain cancer research in honour of Tessa Jowell The funding is double the original amount and will be used to encourage new research and clinical practice to improve outcomes for people with brain tumours.
The measures include:
doubling the government research fund to £40 million – part of a £65m research package launched this year
starting to use gold standard dye across the UK – this dye is used to identify brain tumours during surgery and is currently only used in half of brain cancer centres in England
speeding up the use of adaptive trials – to test different treatments at the same time and speed up the process
an annual global conference to bring together world experts on brain cancer, to be hosted by the government
A survey that asked members of the public about the causes of cancer has revealed that general public have misconceptions and ignorance about the causes of cancer. A joint project with University of Leeds and University College London (UCL) surveyed over 1300 people to explore public understanding about some of the causes of cancer (via University of Leeds).
Although they recognised proven causes of cancer including smoking (recognised by 88%) passive smoking (cited by 80% ) passive smoking and excessive sun exposure (sunburn 60%), as risk factors; 19 per cent of those surveyed also noted drinking from plastic bottles, residing near power lines and eating genetically modified food.
Among the key findings were three quarters of the sample were unaware that eating less than five a day portions of fruit or vegetables raises the risk of getting the disease. Others in the sample (40 per cent) believed stress and food additives caused cancer.
The full news item from The University of Leeds can be read here
Literature on population awareness about actual causes of cancer is growing but comparatively little is known about the prevalence of people’s belief concerning mythical causes of cancer. This study aimed to estimate the prevalence of these beliefs and their association with socio-demographic characteristics and health behaviours.
A survey containing validated measures of beliefs about actual and mythical cancer causes and health behaviours (smoking, alcohol consumption, physical activity, fruit and vegetable consumption, overweight) was administered to a representative English population sample (N = 1330).
Awareness of actual causes of cancer (52% accurately identified; 95% confidence interval [CI] 51–54) was greater than awareness of mythical cancer causes (36% accurately identified; 95% CI 34–37; P less than 0.01). The most commonly endorsed mythical cancer causes were exposure to stress (43%; 95% CI 40–45), food additives (42%; 95% CI 39–44) and electromagnetic frequencies (35%; 95% CI 33–38). In adjusted analysis, greater awareness of actual and mythical cancer causes was independently associated with younger age, higher social grade, being white and having post-16 qualifications. Awareness of actual but not mythical cancer causes was associated with not smoking and eating sufficient fruit and vegetables.
Awareness of actual and mythical cancer causes is poor in the general population. Only knowledge of established risk factors is associated with adherence to behavioural recommendations for reducing cancer risk.
Oxford University | April 2018 | Weight loss is an important predictor of cancer
A team of scientists from Oxford and Essex Universities conducted a systematic review and meta- analysis to examine all the literature on the association between weight loss and cancer in primary care. This robust study, the first of its kind in this area, demonstrates that unintentional weight loss is the second highest risk factor for colorectal, lung, pancreatic and renal cancers (via Oxford University).
Their analysis of 25 studies, over 11.5 million patients -predominantly in primary care 22 of the studies or 92% – used data coded by clinicians in primary care. Four-fifths of these data defined weight loss as a physician’s coding of the symptom; the remainder collected data directly. An association was identified with weight loss linked with 10 cancer sites: prostate, colorectal, lung, gastro-oesophageal, pancreatic, non-Hodgkin’s lymphoma, ovarian, myeloma, renal tract, and biliary tree.
This also showed that people aged over 60 with unexpected weight loss have more than 3% chance of having cancer in one of the 10 cancer sites. In females in this age group, the average risk across all sites involved was estimated to be up to 6.7%, and in males up to 14.2%.
The authors of the study conclude that a a primary care clinician’s decision to code for weight loss is highly predictive of cancer.
The article has been published in the British Journal of General Practice online ahead of print.
Background Weight loss is a non-specific cancer symptom for which there are no clinical guidelines about investigation in primary care.
Aim To summarise the available evidence on weight loss as a clinical feature of cancer in patients presenting to primary care.
Design and setting A diagnostic test accuracy review and meta-analysis. Method Studies reporting 2 × 2 diagnostic accuracy data for weight loss (index test) in adults presenting to primary care and a subsequent diagnosis of cancer (reference standard) were included. QUADAS-2 was used to assess study quality. Sensitivity, specificity, positive likelihood ratios, and positive predictive values were calculated, and a bivariate meta-analysis performed.
Results A total of 25 studies were included, with 23 (92%) using primary care records. Of these, 20 (80%) defined weight loss as a physician’s coding of the symptom; the remainder collected data directly. One defined unexplained weight loss using objective measurements. Positive associations between weight loss and cancer were found for 10 cancer sites: prostate, colorectal, lung, gastro-oesophageal, pancreatic, non-Hodgkin’s lymphoma, ovarian, myeloma, renal tract, and biliary tree. Sensitivity ranged from 2% to 47%, and specificity from 92% to 99%, across cancer sites. The positive predictive value for cancer in male and female patients with weight loss for all age groups greater than 60 years exceeded the 3% risk threshold that current UK guidance proposes for further investigation.
Conclusion A primary care clinician’s decision to code for weight loss is highly predictive of cancer. For such patients, urgent referral pathways are justified to investigate for cancer across multiple sites
Full reference: Nicholson, B. D., Hamilton, W., O’Sullivan, J. Aveyard, P, Hobbs, FD R. 9 April 2018| Weight loss as a predictor of cancer in primary care: a systematic review and meta-analysis | Br J Gen Pract | DOI: 10.3399/bjgp18X695801
Liu, J., et al | 2018 | An IntegratedTCGAPan-CancerClinicalDataResource to DriveHigh-QualitySurvivalOutcomeAnalytics | Cell | 73 | Vol. 2| P. 400-416| e11 | Doi: 10.1016/j.cell.2018.02.052.
Researchers in the US argue that based on the findings of a study that looked at 33 cancer types in more than 10,000 patients, cancers should in future be categorised according to similarities in tumour types; rather than where they are first formed. The researchers suggest they could reclassified into clusters that shared molecules.
For a decade, The Cancer Genome Atlas (TCGA) program collected clinicopathologic annotation data along with multi-platform molecular profiles of more than 11,000 human tumors across 33 different cancer types. TCGAclinicaldata contain key features representing the democratized nature of the data collection process. To ensure proper use of this large clinical dataset associated with genomic features, we developed a standardized dataset named the TCGAPan-CancerClinicalDataResource (TCGA-CDR), which includes four major clinicaloutcome endpoints. In addition to detailing major challenges and statistical limitations encountered during the effort of integrating the acquired clinicaldata, we present a summary that includes endpoint usage recommendations for each cancer type. These TCGA-CDR findings appear to be consistent with cancer genomics studies independent of the TCGA effort and provide opportunities for investigating cancer biology using clinical correlates at an unprecedented scale.
Generation of TCGA Clinical Data Resource for 11,160 patients over 33 cancer types
Analysis of clinical outcome endpoints with usage recommendations for each cancer
Demonstration of data validity and utility for large-scale translational research
NHS England | New ‘one stop shops’ for cancer to speed up diagnosis and save lives |
Rapid diagnostic and assessment centres are being piloted in ten areas as part of NHS England’s drive to catch cancer early and speed up diagnosis for people with cancer. These pilots form the Accelerate, Co-ordinate and Evaluate (ACE 2) Early Diagnosis Programme, a joint initiative by NHS England, Cancer Research UK and Macmillan. These new centres are part of NHS’s plan to meet the new faster diagnosis standard, where patients with suspected cancer should receive a diagnosis or the all clear within 28-days. Those diagnosed, with cancer can be referred on to specialists, those with benign conditions will be directed to appropriate treatment and receive tailored advice about prevention. It is anticipated that if the pilot is successful the programme will be rolled out across England.
While these pilots are the first multidisciplinary diagnostic centres in England, the concept comes from Denmark, where it was developed in response to patients presenting with vague symptoms being referred for multiple tests, when they required an urgent diagnosis.
All of the centres have the same purpose – to diagnose cancers early in people who do not have ‘alarm symptoms’ for a specific type of cancer, but each of will operate in a different way to address the needs of their local communities. The ten centres are located at:
North Middlesex University Hospital,
University College London Hospital,
Southend University Hospital,
Royal Free Hospital
St James University Hospital
Airedale General Hospital
University Hospital South Manchester
Royal Oldham Hospital
The full post and further details of the programme can be found at NHS England
Bowel Cancer UK | Bowel Cancer Awareness Month 2018
April 2018 is bowel cancer awareness month and Bowel Cancer UK has produced a range of resources to raise awareness. Their mission is to ensure that by 2050, no-one will die of bowel cancer.
Bowel cancer is the UK’s second biggest cancer killer however it shouldn’t be because it is treatable and curable especially if diagnosed early. Nearly everyone diagnosed at the earliest stage will survive bowel cancer but this drops significantly as the disease develops. (Bowel Cancer UK)
The resources including more information about the symptoms of bowel cancer are available at Bowel Cancer UK
The poster can be downloaded from Bowel Cancer UK here
Cancer Research UK | March 2018 | More than 2,500 cancer cases a week could be avoided
Cancer Research UK has published findings which demonstrate that almost 4 in 10 ( 37.7 per cent) of cancers could have been prevented. The landmark study highlights that many lifestyle factors could contribute to an individual’s risk of developing cancer. The study identifies 135, 500 cases of cancer a year in the UK that could be prevented through lifestyle changes. The research findings have been published this month in the British Journal of Cancer(thefull abstract at the end of the post).
While smoking was to blame for the largest percentage of preventable cancer cases, using data from 2015 the researchers observed, tobacco smoke caused around 32,200 cases of cancer in men (17.7% of all male cancer cases) and around 22,000 (12.4%) in women.
Obesity is the second highest contributory risk to developing cancer: around 22,800 (6.3%) cases of cancer a year are down to being overweight or obese. This is equivalent to around 13,200 (7.5%) cases of cancer in women and around 9,600 (5.2%) in men. The results imply that 5% (1 in 20) cancer cases might possibly be prevented by maintaining a health weight. Obesity has been linked to 13 different types of cancer, such as cancers of the bowel, breast and kidney.
The third greatest factor in preventable cancers was overexposure to UV radiation from the sun and sunbeds, associated with around 13,600 cases of melanoma skin cancer a year, 3.8% of all cancer cases.
Other preventable lifestyle risks outlined in the study were eating too little fibre causing around 11,900 cases equivalent to 3.3% each, drinking too much alcohol (attributed to causing 11,700 cases or 3.3% each.
In repsonse to the findings of the research, Sir Harpal Kumar, Cancer Research UK’s chief executive, said: “Leading a healthy life doesn’t guarantee that a person won’t get cancer, but it can stack the odds in your favour. These figures show that we each can take positive steps to help reduce our individual risk of the disease.” (Cancer Research UK)
Full reference: Brown, K. F., et al | 2018 | The fraction of cancer attributable to modifiable risk factors in England, Wales, Scotland, Northern Ireland, and the United Kingdom in 2015 |British Journal of Cancer | doi:10.1038/s41416-018-0029-6
Changing population-level exposure to modifiable risk factors is a key driver of changing cancer incidence. Understanding these changes is therefore vital when prioritising risk-reduction policies, in order to have the biggest impact on reducing cancer incidence. UK figures on the number of risk factor-attributable cancers are updated here to reflect changing behaviour as assessed in representative national surveys, and new epidemiological evidence. Figures are also presented by UK constituent country because prevalence of risk factor exposure varies between them.
Population attributable fractions (PAFs) were calculated for combinations of risk factor and cancer type with sufficient/convincing evidence of a causal association. Relative risks (RRs) were drawn from meta-analyses of cohort studies where possible. Prevalence of exposure to risk factors was obtained from nationally representative population surveys. Cancer incidence data for 2015 were sourced from national data releases and, where needed, personal communications. PAF calculations were stratified by age, sex and risk factor exposure level and then combined to create summary PAFs by cancer type, sex and country.
Nearly four in ten (37.7%) cancer cases in 2015 in the UK were attributable to known risk factors. The proportion was around two percentage points higher in UK males (38.6%) than in UK females (36.8%). Comparing UK countries, the attributable proportion was highest in Scotland (41.5% for persons) and lowest in England (37.3% for persons). Tobacco smoking contributed by far the largest proportion of attributable cancer cases, followed by overweight/obesity, accounting for 15.1% and 6.3%, respectively, of all cases in the UK in 2015. For 10 cancer types, including two of the five most common cancer types in the UK (lung cancer and melanoma skin cancer), more than 70% of UK cancer cases were attributable to known risk factors.
Tobacco and overweight/obesity remain the top contributors of attributable cancer cases. Tobacco smoking has the highest PAF because it greatly increases cancer risk and has a large number of cancer types associated with it. Overweight/obesity has the second-highest PAF because it affects a high proportion of the UK population and is also linked with many cancer types. Public health policy may seek to mitigate the level of harm associated with exposure or reduce exposure levels—both approaches may effectively impact cancer incidence. Differences in PAFs between countries and sexes are primarily due to varying prevalence of exposure to risk factors and varying proportions of specific cancer types. This variation in turn is affected by socio-demographic differences which drive differences in exposure to theoretically avoidable ‘lifestyle’ factors. PAFs at UK country level have not been available previously and they should be used by policymakers in devolved nations. PAFs are estimates based on the best available data, limitations in those data would generally bias toward underestimation of PAFs. Regular collection of risk factor exposure prevalence data which corresponds with epidemiological evidence is vital for analyses like this and should remain a priority for the UK Government and devolved Administrations.