Health: Why millions survive cancer

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If the very thought of cancer terrifies you, you’re not alone - the disease is the British public’s number one fear.

But although a recent Cancer Research UK survey found Britons were more frightened of cancer than anything else, the truth is there’s much less to fear about the Big C than there used to be.

New treatments and improvements to older methods of tackling the disease mean that although cancer rates have increased by more than a quarter since 1979, survival in the UK has doubled in the last 40 years, and deaths from the disease have fallen by a fifth over the last three decades.

Among the survivors is Kylie Minogue, who had surgery and chemotherapy after finding out she had breast cancer in 2005. She celebrated five years all-clear of the disease this year.

Not as far down the path are other stars including Michael Douglas, who announced he’d won his battle against throat cancer in January, and former England football captain Bryan Robson, who declared he’d beaten throat cancer last month, just six months after his diagnosis was revealed.

The increasing numbers of people, both being diagnosed with the disease and surviving it, is one of the reasons cancer expert and molecular biologist Dr Lauren Pecorino wrote the book Why Millions Survive Cancer.

Pecorino says greater public awareness of the disease and its causes, together with an increasing understanding of biology and better treatments, mean cancer is no longer quite the demon it once was.

“I think the perception of cancer as a death sentence is changing,” she says.

“We’re being more open about the disease, celebrities are talking about having it and living with it, and people are educating themselves about early cancer symptoms.”

There are over 200 different types of cancer, but they all have two things in common - abnormal growth, and the ability to spread throughout the body (metastasis).

This spread is the biggest clinical obstacle in treating cancer, but important advances in the three common treatment options - surgery, radiotherapy and chemotherapy - mean that even this hurdle can be overcome.

Stereotactic radiotherapy - or cyberknife - can now be used to increase the precision of radiation therapy used to shrink tumours and kill cancer cells.

Doctors aim a number of low dose radiation beams at a tumour from different angles, thus giving a full dose of radiation when the beams meet at the tumour site.

The technique has fewer side-effects than standard radiotherapy, as surrounding healthy tissue is damaged less because the individual beams are low dose.

Advances in cancer surgery include robotic procedures, where the surgeon operates a robot unit to make tiny, accurate movements. Such procedures offer more precision and better patient recovery times.

There are now also ‘molecularly targeted drugs’ which are like missiles going directly to the tumour, as opposed to the old-style “carpet bombing” chemotherapy, which Pecorino likens to a “brute attack” that killed healthy cells as well as cancerous ones.

Pecorino, a cancer biology lecturer at Greenwich University, says personalised medicine - which has been used to treat breast cancer for several decades - is being used more routinely, but is still in its infancy.

It involves genetic testing to identify cancer-causing mutations, and then using targeted drugs to tackle the specific problem.

“It’s using the right treatment for an individual patient, rather than guessing,” explains Pecorino.

But what’s just as vital as the treatments, she says, is avoiding carcinogens (cancer-causing substances) in the first place.

In short, carcinogens stick to DNA and mask it so it can’t be read properly in the cell. This can lead to the creation of faulty proteins which contribute to abnormal cell growth.

It’s thought that an accumulation of such mutations over time leads to cancer, and that’s one of the reasons that it’s a disease of ageing.

All cancers are caused by carcinogens, which are in the environment and in our diet, and include radiation - such as that from the sun which can lead to skin cancer - and infections like the human papilloma virus, which can lead to cervical cancer.

But it’s not easy to avoid infections, and the best way to reduce the overall risk of cancer is through a healthy lifestyle.

That means a diet packed with fruit and vegetables, maintaining a healthy weight, exercising, reducing alcohol intake and not smoking.

Pecorino stresses: “The fact that we can make lifestyle changes to decrease cancer risk needs to be emphasised - it needs to be screamed from the highest mountain.”

While it’s known that such changes can help, in many cases the reasons behind the effect aren’t yet fully understood.

“You need to stack the cards in your favour,” says Pecorino. “But if you do get cancer, remember that the statistics are pointing out that it’s becoming a chronic disease - something you can live with.”

Dr Julie Sharp, senior science information manager at Cancer Research UK, says much of the recent success in the fight against cancer has been with specific cancers, with particularly good survival improvements for breast, testicular, bowel and children’s cancers.

The progress is both because of better treatments, she says, and international trials where doctors have pooled information to establish the best combinations of treatments.

“Our challenge for the next 30 or 40 years is to translate that success for the cancers that are harder to treat, like brain and pancreatic cancers,” explains Sharp.

She points out that screening programmes for breast, cervical and bowel cancer are also improving the cancer landscape, particularly as the cervical and bowel screening programmes can prevent as well as detect cancer.

That’s something DJ Chris Evans can vouch for. The Radio 2 DJ, whose father died from colon cancer, had a routine colonoscopy in July and had two pre-cancerous growths removed.

While Evans was clearly worried about his own health because of the link to his father, it’s estimated that inherited factors cause just 10% of all cancers.

But whatever the cause, they all need treating, and Sharp warns: “Sadly, there probably won’t ever be one magic bullet.

“There are so many different cancers, and so many different faults in the body that lead to the disease, we’re unlikely to have one thing that can target all of them.”

However, she says current work on the genetic mapping of cancers could mean more major treatment improvements in future, and she adds: “Each cancer is different and has its own challenges. But there’s been huge progress - and there’s much more to come.”

Cancer facts:

l There were around 309,500 new cases of cancer diagnosed in 2008 in the UK.

l Up to half of all cancers could be prevented if people made changes to their lifestyle.

l Breast, lung, bowel and prostate cancers together account for more than half of all new cancers.

l At least three-quarters of children with cancer are now cured, compared to a quarter in the late 1960s.

l Almost two-thirds of women with breast cancer survive their disease beyond 20 years.

l More than three out of five cancers are diagnosed in people aged 65 and over.

l More than a quarter of deaths from cancer (including almost 90% of lung cancer deaths) are linked to smoking.

l Current levels of obesity and being overweight could lead to around 19,000 cases of cancer each year in the UK.

l Alcohol consumption is estimated to cause at least 13,000 cancers in the UK each year.

l Why Millions Survive Cancer: The Successes Of Science by Lauren Pecorino is published by Oxford University Press, priced £16.99. Available now

l For more information on cancer, visit www.cancerresearchuk.org