Cancer isn’t the biggest killer in the UK – that dubious honour still goes to heart attack and stroke. But the word certainly strikes fear into every sane person’s heart. However, while we can’t pretend to have conquered cancer, we have made real inroads.
One of the biggest problems has been picking up cancers early – we have treatments that can dramatically improve the prospects for most cancers these days, as long as they’re treated at an early stage, before they’ve spread to the rest of the body. Screening programmes, such as the long-running breast and cervical cancer systems, have made a big difference. So have awareness campaigns – seeing your doctor if you have a breast lump, blood in your poo, a cough that lasts more than three weeks (especially if you’re a smoker) or a mole that changes shape or colour is crucial.
Lung cancer kills more men than bowel and prostate cancer together, and more women than breast cancer. It’s often silent until it’s quite advanced, and just 1 in 18 people diagnosed are alive five years later. But even here, there’s hope on the horizon.
Lung cancer – a small light at the end of the tunnel
For the first time in years, there’s the prospect of real hope for lung cancers with new ‘targeted’ treatments. Lung cancers aren’t all the same – in fact, up to 2/3 of them have genetic mutations which could make them a target for ‘designer drugs’ which just block that lethal mutation. That means there are new drugs out there and more on the way - they have only a few, really mild side effects and can be taken as a daily tablet, but can double survival rates for some sufferers.
In the last 40 years, survival rates from bowel cancer have doubled, and a new screening service could see that improved even more. Every two years from the age of 60-74 (in England, Wales and Northern Ireland) or 50-74 (in Scotland) everyone now receives a letter with a ‘faecal occult blood’ (FOB) test kit. It’s estimated that if everyone took the test, we could cut the number of people dying of colon cancer by 16% - saving 2,500 lives a year in the UK. And of course, most people will get the all-clear from the test, giving them added peace of mind.
Lung cancer – first things first
To know what treatment is most likely to work, we need to have a sample of the cancer – and that’s been more difficult with lung cancers, where the cancer is buried deep inside the chest. Now a new technique called EBUS allows samples to be taken using ultrasound guidance in just half an hour. The tissue can then be tested for gene mutations using molecular testing, allowing treatment to be targeted to you. But at the moment there’s a postcode lottery for this testing, meaning people may not be getting access to the best treatment – we’re working on a national testing system, but there’s more work to be done
Alcohol and breast cancer – the hidden killer
New research shows that every daily unit a week you drink of alcohol increases your risk by 7-10%. Keeping alcohol for special occasions could do you more good than you know.
Breast cancer – a blow for women’s health
Fifty years ago, women dreaded breast cancer for good reason –three quarters of women diagnosed with it died from it, and even if they didn’t the treatment was drastic. Today, three quarters of women survive, and new discoveries are coming along all the time.
- Women at high risk of breast cancer (because of strong family history) can now be offered tamoxifen, a tablet used to treat breast cancer, to stop them getting it in the first place
- If you have breast cancer, taking tamoxifen for 10 rather than 5 years may cut your risk of the cancer returning by one quarter
- All breast cancers can now be routinely tested for ‘receptors’ (oestrogen and HER2), allowing targeted treatment for the best chance of responding with the fewest side effects
- On the horizon is ‘oncotesting’, a gene test to distinguish aggressive cancers from less dangerous ones, avoiding unnecessary treatment.
Screening – a word of caution
It’s not surprising that many of my patients assume that screening is risk-free – after all, it’s designed to pick up cancers earlier, when survival rates are better and less drastic treatment is required. But screening which picks up an abnormality that’s actually there is called a ‘true positive’, and getting the all-clear when there’s nothing wrong is a ‘true negative’. Unfortunately, ‘false negatives’ (a normal screening test when in fact there is a problem) do occur. For instance, prostate cancer screening with PSA testing misses about 15% of cancers and about 2% of high-grade cancers. There’s also a risk of ‘false positives’, which put you through all the anxiety and trauma of a positive result when there’s actually nothing wrong. While it’s estimated that 1,300 lives a year are saved in the UK by the national breast screening programme, that same programme is thought to result in 4,000 women getting a diagnosis of, and treatment for, cancer that either doesn’t exist or that wouldn’t do them any harm.
Does that mean you’re better off just ignoring any invitation to screening? No, absolutely not. But you need to know the risks and benefits so you can decide where your priorities lie
With thanks to ‘My Weekly’ magazine where this article was originally published.
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