Diagnosing a cancer early is one of the factors that can make the biggest difference in its successful treatment.
Launched in 2008, the National Awareness and Early Diagnosis Initiative (NAEDI) is a partnership between Cancer Research UK and the Department of Health that aims to tackle diagnosing and detecting cancers early.
One of its key aims is to jump-start research into this crucial area, and last month, a diverse group of researchers descended on the Cancer Research UK Cambridge Institute for the second NAEDI research conference, to discuss different aspects of research on early cancer diagnosis.
Following an introduction and welcome from Cancer Research UK’s chief executive, Dr Harpal Kumar, the conference kicked off with a fascinating talk from US researcher Dr Christine Berg, the lead investigator on the USA’s national lung cancer screening trial.
The USA National lung cancer screening trial
Dr Berg’s talk gave an overview of a pioneering lung cancer screening trial in the US. The trial recruited over 50,000 heavy smokers and former smokers, and compared two ways of detecting lung cancer: three annual screens of either low-dose helical computed tomography (CT) or standard chest X-rays.
Both these techniques can be used to detect lung cancers, but CT scans were found to be more effective than chest X-rays: they deliver a far lower dose of radiation and can spot cancers better as they offer a cross-sectional image of the lungs.
However, while CT scans were found to reduce cancer deaths in smokers by 20 per cent, Berg explained that the risk of false positives – detection of cancers that wouldn’t need treatment – was very high. Also despite the lower dose of radiation involved, there remains a risk of cumulative radiation damage to anyone who attends the screening.
Berg and the rest of her team are working out whether CT lung screening is worth the risk it poses to participants despite the fact that it reduces deaths from lung cancer. Screening for any cancer is a complex issue and the benefits need to be weighed up against the risks through large-scale studies like this one.
A key piece of evidence in the pipeline is a detailed economic analysis of the lung screening trial – we’ll be keeping an eye out for it over the coming months.
Keeping track of the numbers
Following Dr Berg’s talk, the rest of the morning covered a range of topics – from the uptake of screening programmes by patients with diabetes and those from ethnic minorities, to using questionnaires to identify people most at risk from lung cancer.
Dr Jem Rashbass, from Public Health England, began the afternoon session with an insight into his experience of helping to ‘modernise’ the National Cancer Registry – the database which holds information about cancer incidence and survival across the UK population. He explained how 90 per cent of cancer cases are now recorded on the database within three months of diagnosis, down from a previous lag of up to two and a half years.
The Registry was also used to demonstrate the success of a bowel cancer awareness campaign in East Anglia, in which it linked the increase in bowel cancer referrals to an ad campaign shown on local television. Dr Rashbass spoke enthusiastically about “one of the miracles” that’s emerging from the new focus on data.
This dataset, called SACT, is just getting off the ground, and should provide a detailed picture of how different cancer drugs are being used around the NHS.
Recognising the symptoms
The second afternoon session opened with Dr Yoryos Lyratzopoulos from the University of Cambridge, who talked about his research into ‘stratifying’ cancer symptoms.
Dr Lyratzopoulos explained how our understanding of – and ability to recognise – symptoms for particular cancers varies hugely between different forms of the disease. While the symptom ‘signatures’ of some cancers – like breast and melanoma - are highly specific and well understoo, others – such as multiple myeloma, pancreatic, ovarian and lung cancers – are much harder to identify.
To improve diagnosis for these difficult-to-spot cancers, Lyratzopoulos suggests that we need to develop new or better diagnostic tests. But just because a cancer is easy to spot, it does not mean the job is done: lack of awareness of symptoms and patient delay in visiting the doctor can make a big difference to how soon the cancer is diagnosed.
Further work needs to be done in many cancers to encourage people to visit their GPs with any persistent symptoms.
iPads and patients’ choice
Diagnostic tests were also the subject of a talk by Professor Willie Hamilton from the University of Exeter who gave an update on the Discovery programme – a partnership between medical services and academics to improve the pathways to patient diagnosis.
Professor Hamilton presented the findings of the Pivot study which attempted to understand which factors influence a patient’s decision to undergo cancer investigation. Patients were given iPads containing information about the symptoms and risks of some cancers.
They were then asked if, given the information they had on the symptoms and risks, they would want the symptoms to be investigated.
The surprising finding was that 90 per cent of the time people said they would prefer to get those symptoms investigated – even if the risk of having the cancer was very low. While promising though, Hamilton pointed out the patients were only deciding on hypothetical situations – their real feelings about going for a test might be different under genuine circumstances.
Further afternoon talks included analysing the costs of early awareness campaigns for lung and bowel cancer. One thing that stood out was the high ‘cost effectiveness’ of such campaigns, when measured using criteria similar to those used by NICE to assess treatments. Clearly, getting early diagnosis right could have a huge benefit for our cash-strapped health service.
With all this focus on doctors and data, it could have been easy to forget about why we were all there. A timely reminder was Richard Stephen’s story of how he survived Hodgkin lymphoma so that he could see his daughter apply for medical school. This illustrated clearly and poignantly why research into early diagnosis and detection of cancers is so important.
The overall impression left by the 2013 NAEDI Conference was that of a new, vibrant research community, and of the great depth and variety of work going on in the area of early diagnosis and detection of cancer.
Most of the research being presented was merely preliminary data and most of the researchers are only part of the way through grants that will run to 2015, which is the date of the next NAEDI conference.
We have high hopes for the progress they’ll have made by then.