The latest cancer news

• Angelina Jolie’s decision to have a double mastectomy to reduce her risk of breast cancer, after she learnt she carried the BRCA1 gene, resulted in blanket coverage across the media this week. You can read about her reasons for undergoing the surgery in this courageous New York Times piece. We also answered some of the frequently asked questions about inherited breast cancer risk and the BRCA1 gene. 

• We spotted several excellent comment pieces in response to Ms Jolie’s news. She’d “done something extraordinary”, according to Hadley Freeman in the Guardian, a sentiment broadly echoed by Lisa Markwell in the Independent, who has had breast cancer herself.

• The Guardian’s data blog took a look at the bigger picture of breast cancer worldwide.

• We also published this moving article about a personal experience of being told you have the BRCA1 gene.

• Experts – including Cancer Research UK’s Professor Diana Eccles – warned that demand for breast cancer gene tests could cause problems for the NHS.

• Why do individual stories like Angelia Jolie’s always have a greater impact on attitudes and behaviours than cold, hard stats? This fascinating Scientific American article explores the power of the personal over the impersonal.

• With the Government’s Spending Review due in June, people have started campaigning for the UK’s science budget to be protected. The Guardian’s bloggers had a look at a new report from the Royal Society of Chemistry, while we covered a related meeting in Parliament.

• The science budget was also the focus of a letter to The Times, covered here by the Association of Medical Research Charities. Our CEO is a signatory.

• Scientists identified four new genetic variants associated with an increased risk of testicular cancer. OnMedica have more detail.
• This BBC article about NHS dental charges and “the hidden cost of mouth cancer” caught our eye.

• The Health Research Authority – which aims to protect and promote the interests of patients and the public in health research – outlined its plans to ensure that clinical trial findings are published. Pharma Times have more detail, and the AMRC blog had a good take on it too.

• A new drug for advanced prostate cancer, alpharadin became available in the US – we hope it will arrive on these shores in due course. Fierce Biotech looked at the announcement and the context.

• People with skin cancer may be less likely to develop Alzheimer’s disease, according to research published on Wednesday. Of course, the results do not mean that people should stop taking measures to avoid skin cancer. The Alzheimer’s Society covered the research.

• Plans to relax the smoking ban in Wales so actors can light up on film and TV sets have been dropped, say the BBC.

• More than half of Britons do not use enough sunscreen, according to the Daily Mail.
• NHS Choices had a balanced take on headlines about redheads and skin cancer.

• Monitoring lactate within tumours using high-tech scans could tell doctors whether or not cancer drugs are working, according to research at our imaging centre at The Institute of Cancer Research. More info here.
• Cancer patients are “being neglected” in hospital, according to a survey by Macmillan Cancer Support. The Guardian has more info.
• We loved this BBC video about diseases under the microscope.

And finally

• We spotted this, ahem, interesting testicular cancer awareness campaign from Brazil… it couldn’t happen here (or could it?). Here’s our information about the symptoms of the disease.

Fran Balkwill plans to build the world’s first artificial tumour

In 2000, a team of archaeologists in the ancient Egyptian city of Thebes uncovered the mummified remains of a young woman called Tabaketenmut. The big toe of her right foot was missing. In its place was a wood and leather contraption tied to the limb with string, which researchers believe to be the earliest example of a prosthetic body part.

This rudimentary device – developed more than 2,000 years ago to help a woman walk – is often cited as one of the first and most primitive examples of bioengineering, the use of artificial components to replace damaged or absent parts of the body.

Today the term has a much broader meaning and includes disciplines such as materials science, biology, mathematics, engineering and computing. And we’ve come an incredibly long way since – thanks to primitive bioengineering – Tabaketenmut walked the earth.

Just last month, we heard the astonishing news that scientists have been able to grow a functioning kidney in the lab. And researchers in the US have developed a high-tech ‘lung on a chip’ to help them study infections and other diseases.

Now Cancer Research UK scientist Professor Fran Balkwill is looking to make a similarly monumental step forward in cancer biology by bioengineering the first ever three-dimensional artificial tumour.

She hopes the work will underpin the development of new treatments that attack the interactions between cancer cells and healthy tissues that unwittingly support them, known as the microenvironment.

Rogue organ

Only a few years ago a project of this scope would have been unthinkable. Although both healthy cells and cancer cells have been routinely grown in the lab for decades, no one has yet come close to reconstructing accurately the complex ecosystem of cells that make up a tumour.

Cells growing in the lab

Professor Balkwill is based at Queen Mary University in London, and we’ve proudly supported much of her work over the years. When we spoke to her about her ambitious project, she explained that even at the earliest stages of development, cancers are more than just a group of cells with cancerous potential.

Instead, Professor Balkwill prefers to think of cancer as a ‘rogue organ’.

A normal organ – such as your liver or lungs – is made of several different cell types such as those that make blood vessels, immune cells that protect against infection, and fibroblast ‘builder’ cells that give the organ its structure.

But Professor Balkwill says that while many of these normal, healthy cells are present in cancer, they are coerced and corrupted by the malignant cells forcing them to grow and spread.”

For example, the blood vessel cells in a cancer don’t behave as they should, and instead form very abnormal and leaky vessels.

“On top of this, the immune cells can’t work properly because their normal ‘good’ functions have been suppressed by the cancerous cells”, she says, “and the fibroblasts grow too much and produce too many growth factors that help the cancer cells grow and expand.”

This dynamic mixture of normal cells and cancer cells is also known as the tumour microenviroment. Professor Balkwill has spent much of her distinguished career working to unlock the secrets of the microenvironment to find ways to tackle cancer.

CANBUILD: ovarian cancer

In particular, Professor Balkwill is determined to discover more about the role of the microenvironment in ovarian cancer.

This latest project – funded by the European Research Council – is shaped and complemented by her Cancer Research UK-supported work. Called CANBUILD, the five year project will bring together a diverse team of world experts to build a living ovarian tumour microenvironment.

Professor Balkwill hopes specifically to reveal more about the inner workings of a type of ovarian cancer called high-grade serous carcinoma (HGSC), the most common and lethal form of the disease.

Mouse model of ovarian cancer showing cancer cells in green, immune cells in pink and blood vessels in red

By the time women with ovarian cancer start to notice symptoms and are diagnosed with the disease, it has often already spread (metastasised) into the abdomen, which makes it much harder to treat successfully. Through her Cancer Research UK work, Professor Balkwill has already been using tissue samples from patients, as well as animal models, to study the complex microenvironment machinery that’s at work in these tumours. Her aim is to develop new treatments to target them.

For example, she’s working with our tech transfer arm Cancer Research Technology and pharmaceutical companies Affitech and AstraZeneca on ways to block a molecule called CCR4, which works on various immune cells in the tumour microenvironment.

Her team has also already developed a rudimentary three-dimensional model of ovarian cancer with three different cell types. Professor Balkwill now wants to take this research to the next level by building a whole living ovarian tumour in the lab – a complex three-dimensional human cancer in which the many different cell types of the microenvironment will communicate, evolve and grow.

Although it will be tiny in size – just a few millimeters across – the task is huge in ambition. And to meld successfully the many different cell types that make up a tumour she needs a successful meld of expertise from different scientific disciplines.

But recent developments in cancer stem cell biology, tissue engineering, mechanobiology and other fields mean that the timing is perfect to attempt such an elaborate project, according to Professor Balkwill.

Perfect timing

She has brought together a crack team of experts – many already supported by Cancer Research UK – who will each bring a unique set of skills to the venture:

• Dr Thorsten Hagemann, a Cancer Research UK Senior Clinical Fellow, who’s an expert on the tumour microenvironment and in translating research into clinical trials;

• Dr James Brenton, a Cancer Research UK clinician scientist with expertise in ovarian cancer molecular biology and genetics, and cancer stem cells;

• Dr Michelle Lockley, a Cancer Research UK clinician scientist specialising in ovarian cancer;

• Professor Sussan Nourshargh, an expert in immunology, inflammation and state-of-the art microscope methods;

• Dr John Connelly, a tissue engineer with expertise in building artificial tissue scaffolds called ‘hydrogels’;

• Professor Ian MacKenzie, a cancer stem cell expert;

• Professor Martin Knight, an expert in mechanobiology and bioengineering;

• Dr Jeff Hubbell, an expert in biomaterials and tissue engineering.

Watch this space

Professor Balkwill describes the project as “blue sky research” that will stretch the skills and imagination of every member of her team, and could lead to a significant shift in how we study tumours in the lab. Her hope is that by more accurately reflecting how cancers behave in the human body, the model her team build will be a vital new weapon in the fight against the disease.

Her vision is to bring forward a “new approach to cancer treatment, where we attack both the supporting microenvironment and the cancer cells,” she says.

Just as the world of prosthetics has moved on dramatically from the days of Tabaketenmut’s crude artificial toe to the bespoke carbon fibre and robotic limbs of today, cancer treatment has improved dramatically. Powered by an ever-growing understanding the disease, we’re moving towards an era of precision medicines that are tailored more specifically to the genetic and molecular drivers of different tumours.

The ultimate aim of the CANBUILD project is to use the model as a testbed for targeted cancer treatments that exploit weaknesses in the interface between tumour cells and components of the microenvironment. And Professor Balkwill says her work is “only a small part of a vast national and international effort” that is uncovering so much new and exciting information about cancers. “This is already translating to new ways of detecting, preventing and treating cancer,” she says.

Alongside her CANBUILD funding, Professor Balkwill has also secured further funding from us to continue investigating ovarian cancer and how to treat it better. A key aim is that three years into the Cancer Research UK-funded programme they will be able to begin to use the CANBUILD model as another experimental tool.

If the work is successful, Professor Balkwill also hopes to develop sophisticated models of other cancers in the future.

Watch this space for further updates on the project.

Olly

• Read more about the tumour microenvironment

Rebecca Hull, 41, has had a preventative double mastectomy after discovering that she carries a faulty copy of the BRCA1 gene. She works for Cancer Research UK.

Seeing Angelina Jolie talking in the media so prominently this week does have a huge impact on people like me.

I think her announcement will make it easier for me to talk about my experiences, and I feel that I don’t have to justify my decision to people as much – it makes it more acceptable.

I grew up knowing my mum’s mum died in her late 40s of ovarian cancer and I was aware that mum had cousins who died from breast cancer in their 30s.

Then, in the early 1980s, when she was 38, mum had had breast cancer – and a mastectomy.

In 2006, she felt unwell again and, after initially being repeatedly misdiagnosed with IBS and then a chest infection, she was found to have ovarian cancer.

After some confusion, she was finally told she had advanced (stage 4) cancer, and she was given intensive treatment including carboplatin chemotherapy, surgery – and then more chemotherapy. She responded well initially, but the cancer returned, with shadows on the liver and lung.

She had more chemotherapy but the cancer returned again in 2008 – mum knew there was no beating it this time. She was 63 then and was put onto palliative treatment.

Having the gene test

At about the same time, I had been to the doctor for antenatal checks and, in passing, mentioned my family history. My GP took notice and referred me to the clinical genetics department at Guys Hospital in London. In early 2009 we discovered mum had a BRCA 1 gene mutation, so I had a blood test at Guy’s to find out whether I had a genetic risk of the disease too.

I was called back in April to be told I had inherited the BRCA1 mutation and I had a very high chance of developing cancer.  I remember that appointment so vividly, it was a pivotal moment and my life changed forever.

The hospital team at Guy’s were amazing – and I had a multidisciplinary team of specialists who were able to give me advice and support.

Over that summer, I had to tell my mum’s brother, and they had to think about taking the tests too. As it turned out, my uncle tested negative, so I’m the only one currently affected in the family, although I have two daughters and we currently don’t know their status. It was a huge relief that none of my cousins inherited the gene, but it has become a bit of an elephant in the room now that I am the only one.

While all this was happening, I was working and caring for mum, who was deteriorating. She died in October. It was a terrible time.

Rebecca with her children

Having two children, and having seen family members die from breast cancer at the age I was, I decided that I had to have the surgery and, on Valentine’s Day 2010, I had a bilateral mastectomy with reconstruction at the same time.

It was an 11-hour operation and I had to go into intensive care afterwards. I ended up spending 10 days in hospital.

I was off work for three months and it has had a huge impact on my life.  And although the reconstruction didn’t quite go to plan, and I am still having revision surgery to correct this, I have no regrets.

I feel that I have two big challenges ahead of me still:

First, I have to tackle my ovarian cancer risk. This will involve more surgery, as there’s currently no screening programme or understanding as to whether screening would be effective.  In some ways, I am more reticent about this surgery as it comes with significant side-effects as a result of the early menopause that removal of the ovaries brings about.

But the second and probably biggest challenge involves my two daughters. They are both under 10 and there’s a 50/50 chance they will have inherited the BRCA gene. I must plan for how this could impact their lives, so they grow up aware but not scared.

It is going to be difficult but I’m hoping research will improve the situation as they grow up.

Research in the last 30 years has given us so much knowledge, and I hope that this progress will continue so that their future options will be better.

And I’m especially proud to work for an organisation like Cancer Research UK that has such a great track record of research into breast cancer genetics and prevention.

After all, Cancer Research UK scientists helped pinpoint the BRCA1 gene, and this has led to some huge advances in understanding breast cancers. I know that this work was too late for my mum, but it wasn’t too late for me. And I hope they will continue to make progress that will have a huge impact for my daughters too.

It can be hard at times knowing that this defect has caused so much loss in my life, and could create more havoc. But I do feel immensely grateful that I‘ve had options to manage my risk of developing cancer, and I am undoubtedly in a better position than my mum and the generations before her.

Rebecca

Government spending on research brings crucial benefits

These are difficult times for the economy. Next month, the Government is set to announce the results of its recent Spending Review, looking at how much it is going to spend on each area of the UK’s economy.

Yesterday, at a meeting in Parliament, our chief executive Dr Harpal Kumar championed the crucial role of medical research in the UK. He was speaking at an All Party Parliamentary Group on Medical Research event about “Investing in medical research for the UK’s future”. 

It was a great chance for Harpal to talk about the fantastic, life-saving medical and scientific research that’s going on in the UK, and how it’s vital that our Government maintains its spending on science.

Harpal outlined the significant benefits to patients that Government spending on research can bring about. The £332 million we spent last year on research was raised solely from generous public donation. But just like other medical research charities, we rely on Government spending to create infrastructure to create the right research environment for us to spend your money effectively on beating cancer.

Harpal likened spending on scientific infrastructure as akin to spending on major transport or housing projects: “There are immediate wins, and the country also reaps long-term social and economic benefits which far outweigh the upfront costs,” he said.

Sir Paul Nurse, President of the Royal Society (and a former CEO of Cancer Research UK), also spoke at the event about the Francis Crick Institute. Sir Paul will be the Institute’s first director and Cancer Research UK is one of The Crick’s founding partners – it’ll help drive science and cancer research even further forward. We’re funding it through our Create the Change campaign.

Sir Paul was keen to discuss the opportunities the Institute offers to attract the top scientists and deliver a world-class workforce to UK medical research. He highlighted the need for Government to continue to invest to support this goal.

And politicians also heard the global pharmaceutical industry’s view of the UK’s medical research base. Patrick Vallance from GlaxoSmithKline told them about how academic and industrial partnerships were beginning to bear fruit with more innovative new drugs being developed, following a slump in R&D productivity for over a decade.

Patrick explained that despite the current doom and gloom around the economy, pharmaceutical and medical research companies are increasingly recognising that investment in research partnerships reaps rewards. He was keen to stress that, as companies look to invest in R&D, now is the time to secure the quality and extent of the UK’s world-class science base.

To coincide with the event, yesterday we also launched our new report “Working together: the impact of medical research investment on the health and wealth of the nation“. The report details how medical research in the UK benefits from all the different types of funding and expertise that exists here.

It shows how a mixture of support from Government, charity and industry partners, university research laboratories, and the National Health Service, provides the breadth and diversity that are crucial to tackling existing and future healthcare challenges.

We are using this to further support the case for Government to maintain its spending on science.

After all, as Harpal told our political leaders, spending on science and research delivers such economic growth and benefits patients, the Government should maintain spending “not despite, but because of, the pressure of austerity and hesitant economic growth”.

Dan Bridge and Andrew Hollingsworth, Cancer Research UK Policy Department 

Actress Angelina Jolie has had surgery to prevent breast cancer

The news today is full of reaction to US actress Angelina Jolie’s decision to have surgery to reduce her chances of breast cancer.

She made this difficult decision because, having lost her mother to ovarian cancer, she discovered she carries a faulty copy of the BRCA1 gene – which put her at very high risk of getting both forms of the disease.

If you haven’t read her brave and thoughtful piece in the New York Times, it’s worth doing so.

But in the light of the considerable interest, and the fact that many people will undoubtedly have questions, we wanted to pull together a few quick thoughts and facts on the topic of inherited breast cancer generally, and the BRCA1 gene specifically.

How can you ‘inherit’ breast cancer?

No two people are born the same and, as a result, we all have slightly different chances of developing diseases during our lifetimes. This is the result of natural variation in our genes.

On top of this natural variation, about 1 in 1,000 people inherit a damaged copy of a BRCA1 gene from one of their parents, and this means their chance of developing a breast cancer is far higher than average. Families that carry these gene faults usually have a long history of breast and/or ovarian cancer.

But only a small proportion – about one in 20 (5 per cent) – of the 50,000 women diagnosed with breast cancer every year carries an inherited gene fault like BRCA1. Most breast cancers arise from genetic damage that accumulates over a person’s lifetime (that’s why age is the biggest risk factor).

So when we say these genes cause an ‘increased risk’, what do we mean?

The average woman in the UK has a 12.5 per cent chance of developing breast cancer at some point in her life. In other words, if you follow the lives of a hundred average women, 12 or 13 will eventually develop breast cancer.

But a female BRCA1 carrier has between a 60 and 90 per cent chance of developing breast cancer – in other words, between 60 and 90 out of every hundred BRCA1 carriers go on to develop breast cancer. They also have an around 40 – 60 per cent chance of ovarian cancer.

The precise figure for an individual woman will vary according to several things, such as a her age, the number of affected family members, and the exact nature of the fault in the gene.

In Ms Jolie’s case, she was told she had an 87 per cent chance of breast cancer.

We’ve got extensive information about breast cancer genes on our website.

So how do faults in BRCA1 actually cause breast cancer?

Understanding the BRCA1 gene

The BRCA1 gene makes a protein that repairs damaged DNA

The link between the BRCA1 gene and breast cancer was discovered in 1994 (our researchers played a pivotal role, which you can read about here).

Further research showed that – in most of us – it tells cells to make a protein that helps repair damage to DNA.

So people who inherit a faulty copy are less able to repair damage that accumulates in their DNA over time. And so they’re at higher risk of cancer.

Is surgery the only option?

Women should make the decision that’s right for them. Surgery is not the only option – women can opt to have intensive surveillance, either with mammograms or MRI scans. These can pick up cancers when they’re small, localised, and easier to treat successfully.

There are many factors that affect a woman’s decision, for example how old she is, or whether she’s had (or is planning to have) children. We applaud Ms Jolie’s brave decision to speak publicly about her experiences, but we also want women to know that they shouldn’t feel pressured to have surgery if they’re not sure this is the right choice based on their own circumstances.

I’m worried I have cancer in my family – what can I do?

Mutations in the BRCA genes cause particular patterns of cancer down the generations. According to the National Institute for Health and Care Excellence (NICE), you may have a higher than average risk of breast cancer if you have one of the following in your family:

• A mother or sister diagnosed with breast cancer before the age of 40
• 2 close relatives from the same side of the family diagnosed with breast cancer – at least one must be a mother, sister or daughter
• 3 close relatives diagnosed with breast cancer at any age
• A father or brother diagnosed with breast cancer at any age
• A mother or sister with breast cancer in both breasts – the first cancer diagnosed before the age of 50
• 1 close relative with ovarian cancer and 1 with breast cancer, diagnosed at any age – at least one must be a mother, sister or daughter

The affected relatives must come from the same side of your family (either your mother’s side or your father’s side) and they must be your blood relatives. A close relative means a parent, brother or sister, child, grandparent, aunt or uncle, nephew or niece.

Risks are also higher among people of Ashkenazi Jewish descent.

If this sounds like you, you should talk to your GP – the NHS has excellent genetic counselling services. We have more information about family history and other proven breast cancer risk factors on our patient information website.

What work is Cancer Research UK doing in this area?

Over the years, supported by the British public, our researchers have played a pivotal role in indentifying and understanding breast cancer genes. Their research helped pin down BRCA1 in 1994 , and they found its close cousin – BRCA2 – a year later. It’s because of work like this that hundreds of thousands of women, including Angelina Jolie, can take positive steps to reduce their risk of the disease.

We’ve also made strides in understanding exactly how these gene faults lead to cancer, and are helping develop drugs called PARP inhibitors, which can target cancers driven by these faults.

And we’ve started to unravel why some BRCA1 carriers are at higher risk than others, which could help women make the tricky decision as to whether to have surgery or surveillance.

As well as our work on faulty genes, we’re also working hard on understanding the natural variation that affects breast cancer risk in the rest of us (albeit to a lesser degree). Just a few months ago, our researchers pinpointed 49 regions of our genetic code that are involved in breast cancer risk. Our vision is that this information can be integrated into the NHS screening programme, targeting screening better across the UK’s population.

You can read more details of our current research on breast cancer, and about our progress over the years.

And that brings us to our final point. Angelina Jolie’s story demonstrates clearly how the fruits of scientific research can help people take positive steps to take the fight to cancer. We’re not helpless – even though some of us are dealt a ‘bad hand’, genetically speaking.

Research has also shown us how those of us at ‘average’ risk of cancer, can take action too – living a healthy lifestyle, knowing the symptoms of the disease, and seeing a GP if you notice anything unusual.

And if you have questions or concerns about the disease, you can contact our nurses – either via email, or on 0808 800 4040, 9am-5pm.

Henry

We have a responsibility to spend our supporters’ donations wisely

Our research is funded by the public – around 80p in every pound donated to us is spent on this vital work – so we have a responsibility to make sure our supporters’ cash gets spent on the very best science that will make a difference to people with cancer.

We’ve written before about how our funding committees allocate millions of pounds, raised by our supporters, to scientists, doctors and nurses across the UK. But we thought it might be helpful to lift the lid on the finer points of our funding processes in a bit more detail. 

The following story is an illustration of what happens when someone applies to us for funding.

We’ve changed the name of the researcher, but all the details are taken from a real-life situation.

It starts with a bright idea…

Dr Sally Labcoat is a children’s cancer doctor at Northerntown University Hospital, specialising in treating children and young adults with brain tumours.

Recently she’s seen several new drugs come onto the market that look promising for her patients, and thinks that a combination of two of them might be useful for treating a relatively rare type of brain tumour.

But she doesn’t know for sure whether mixing the drugs together will be safe and effective, nor what the best dose might be.

To answer these questions, Dr Labcoat decides to apply to Cancer Research UK for a grant to allow her to carry out a clinical trial involving more than a hundred children and young people with this type of brain tumour across Europe.

…And an online application form

To start the process, Dr Labcoat logs onto our electronic Grant Management System (eGMS), an online system that helps researchers apply to us for money for research. eGMS asks questions about every aspect of her idea – the background for the trial, its aims and methods and exactly how much it will cost.

Dr Labcoat also has to provide details of co-investigators and all of their experience, as well as where patients will be recruited and who will coordinate it.

eGMS automatically sends all this information through to the people who manage the appropriate funding committee. In this case, the application is sent to our Clinical Trials Awards and Advisory Committee (CTAAC).

Off to the reviewers

Once submitted, Dr Labcoat’s application is picked up by Naomi, one of our Application and Award Officers, who checks it over to make sure everything is present and correct.

She also confirms that all the financial details comply with our Grant Conditions, which set out our expectations when it comes to the researchers we fund. These cover everything from best scientific practice and our rules around publishing and patenting research, to what grantees should and shouldn’t be spending our supporters’ money on.

While Naomi’s looking at the administrative ‘nuts and bolts’ of the application, Andy – a Research Funding Manager – is looking over the science side of things. It’s his job to find at least three top scientists from Dr Labcoat’s research field to scrutinise her application – a process called ‘peer review’. It’s no mean feat getting all those scientific opinions together – Andy and his team end up asking 15 different researchers before six of them agree to look at the application.

The reviewers make sure that the results of Dr Labcoat’s trial are likely to make a difference to brain tumour patients, and the methods she’s chosen are going to make the results meaningful.

Luckily, it’s a strong application and the reviewers are happy, saying things like “This is a critically important area of research” and pointing out that Dr Labcoat has an “excellent track record”. This bodes well for the next stage – but it’s no guarantee.

Next stop, the funding committee

Three times a year, 25 world-class scientists who are experts in their field come from far and wide to form our CTAAC committee and decide which clinical trial applications to fund.

In March 2013, they meet over two days in London to consider Dr Labcoat’s application along with more than 20 others. But not everything can be funded – we can’t spend money we don’t have, so the committee’s budget is fixed, based on the funds available at the time.

The committee scrutinise all the applications, looking at the researchers’ experience and credentials, the quality of the research, the place where the research will be based and the reviewers’ comments.

And while we don’t allocate certain amounts of money to particular cancer types, the committee will also consider how well the proposals fit with our overall research strategy, and whether they are good value for money.

By the end of the two-day meeting, every application has been allocated a ‘score’ and the money is shared between the top scorers until it runs out. The committee try to fund everything worthwhile, and work hard to suggest savings where they can, so more projects can be funded.

Dr Labcoat’s proposed trial ticks many of the committee’s boxes. Not only is she an experienced researcher with favourable reviews for her application, but the proposal of an international trial involving a rare cancer in children sits nicely within our research strategy (which focuses on hard-to-treat cancers where there’s a real need for improvements in survival). So it’s a “yes” for Sally and her team, and their trial will be funded.

What happens afterwards?

After the committee meeting Reena, one of the research funding team, gives Dr Labcoat a call to break the good news. She also passes on any recommendations the committee have made that will make the trial even better.

One of the Application and Award Officers creates a Grant Award Letter – a type of contract that commits Cancer Research UK to paying for the first year of the trial. Getting the money for subsequent years will depend on how the trial fares, as we’ll see below.

Once she has her Grant Award Letter, Dr Labcoat can hire her research team, get all the ethical approval and red tape sorted out, and – finally – start recruiting patients onto her trial.

Is that it?

Not at all! We keep a close eye on all the research we fund from start to finish, making sure everything is going to plan and is sticking to our high standards. This means that Dr Labcoat will need to write a Scientific Milestone Report every year showing what she’s achieved so far and what will happen in future. Next year’s committee will use this to decide whether to continue funding her trial.

And there’s more. While the committee keeps an eye on the science, our Grant Finance team keeps an eye on the money. Every three years, the University of Northerntown will have to report how much has been spent from Dr Labcoat’s grant. Then, when the trial is over, any unspent funds come back to us, to go towards other lifesaving research projects.

This can add up to millions of pounds every year, so it’s an important part of the finance team’s work.

We also regularly visit universities and other research institutions, taking a magnifying glass to their financial systems to look out for anything we’re not 100 per cent happy with. It means we can be confident that our supporters’ hard-earned and generously-given money is being spent in the most efficient and effective way possible – saving lives through funding the best cancer research.

Kat Arney and Sarah Beaton

The latest cancer news

• Wednesday was a sad day for public health. The worrying rumours we’d heard last week – that the government had scrapped plans to introduce plain, standardised tobacco packaging in the Queen’s speech – turned out to be true. This BBC article has more info. We wrote about why this is a blow in the fight against cancer.
• Our scientists found that genetic ‘fine tuners’ known as microRNAs control the body’s own attack against breast cancer. Read more in our press release
• US scientists uncovered why breast cancer patients with dense breasts are often more likely to develop aggressive tumours that spread. This NewsWise article has more info.
• Also across the pond, researchers at the Stanford University School of Medicine identified a group of proteins that are faulty in about one-fifth of all human cancers. Science Daily covered the story.

• Pharmaceutical companies agreed a substantial discount on the cost of cervical cancer vaccines for the developing world. The New York Times and the Guardian have more detail.

And finally

• We were dismayed this week by several headlines like this: “Sun’s blood pressure benefits may outdo cancer risks”. The study in question only looked at the blood pressure of 24 volunteers who sat beneath tanning lamps. It didn’t directly look at skin cancer risk and also hasn’t been published in a peer-reviewed journal yet. Overexposure to UV radiation from the sun or sunbeds is the main cause of skin cancer, so we advise everyone to enjoy the sun safely.

The 2010 film The King’s Speech was a national triumph. So at Cancer Research UK we’re dismayed to have to report that we’re not exactly rolling out the red carpet for yesterday’s Queen’s Speech.

In fact, quite the opposite.

The Queen’s Speech – which outlined the Government’s focus for the next year – has, shockingly, left plans to put tobacco products in plain, standardised packaging, on the cutting room floor.

The government has thus failed to deliver on a policy that would help protect children from a product that has no safe level of consumption.

So today, nine months since its consultation closed in August 2012, we’re left hanging, still waiting for the government to make a clear statement of its intentions.

In that time more than 150,000 children have started smoking – the beginning of an addiction that kills half its long-term users.

In light of this disappointing decision, we wanted to outline, clearly and simply, which organisations support this measure. Also we thought it worth exposing the vested interests of its opponents. This is all worth knowing, because this fight isn’t over; this is not “The End”.

A quick recap

Along with scores of other health organisations, Cancer Research UK has been campaigning for new laws to put all tobacco products in plain, standardised packs.

This isn’t about discouraging current smokers. It’s about discouraging children from starting – something the evidence shows standard packs will be effective in doing. This is because tobacco packs are the last remaining ‘public space’ left for the tobacco industry to advertise their brands.

As you might expect, the tobacco industry has vehemently opposed this idea – opposition that flies in the face of widespread support from across society.

On the one hand…

Protecting the public health of its citizens should be a top priority for any government.

There is clear support for standardised tobacco packs from the public, and from the public health and welfare community at both national and international levels.

Let’s look at who’s backing the campaign:

• 63 per cent of UK adults support removing all branding from cigarette packs, with just 16 per cent opposed.
• More than 200,000 people support standard packs campaigns - 80,000 of which showed their support through Cancer Research UK’s campaign.
• 190 health and welfare organisations support standard packs. These include Royal Medical Colleges, the British Medical Association and charities such as the British Heart Foundation.
• 85 per cent of people back government action to reduce the number of young people who start smoking.

The World Health Organisation is clear that marketing of tobacco products “encourages current smokers to smoke more, decreases their motivation to quit, and urges youth to start” – and make no mistake, the branding on cigarette packs is marketing.

Our standard packs campaign was a Mumsnet feature campaign in 2012 because parents believe it is important to protect their children from tobacco marketing.

The Trading Standards Institute, EU anti-fraud office representative and Greater Manchester’s Police and Crime Commissioner have dismissed tobacco industry claims that standard packs will increase the illicit trade.  

…but on the other:

In keeping with years of deceit about the deadly harms and addictiveness of their products, the tobacco industry has financed a number of third-party organisations to oppose the policy.

Throughout their opposition to standard packs, industry and pro-tobacco groups have relied on facts and figures drawn from several key sources, leaving the declaration of vested interests for others to discover. So here are just a few:

• KPMG have produced several reports that claim the illicit tobacco trade is growing: these reports were paid for by the world’s largest tobacco company, Philip Morris International. But they contradict the Government’s own figures.
• Transcrime have also produced reports on the illicit tobacco trade: these are also funded by Philip Morris, and report strikingly similar findings
• The Freedom Organisation for the Right to Enjoy Smoking Tobacco (Forest), are a pro-smoking group that has opposed any legislation intended to reduce smoking rates: they are supported by British American Tobacco (BAT), Japan Tobacco International (JTI) and Imperial Tobacco.
• Forest has, in turn, used their own single-issue front-group Hands Off Our Packs (HOOPS) to oppose standard packs: they receive the same veiled support from BAT, JTI and Imperial tobacco.
• The Intellectual Property (IP) firm, Rouse, have written articles which look at the implications for brands’ intellectual property: last week the firm amended their client list, removing Japan International Tobacco, but helpfully staff biographies list tobacco clients among them.
• The Common Sense Alliance includes many members who have spoken out against standard packs: among them, former-police officers who had given evidence to the House of Lords. The Observer reported the Common Sense Alliance is funded by BAT – something the former officers failed to declare.

In July 2012, JTI announced that they would be committing £2m to a campaign opposing standard packs, placing several adverts in national publications throughout and beyond the consultation period. To date the Advertising Standards Authority has ruled that two separate ads are “misleading” and “unsubstantiated”.

A quick note on smuggling: one of the most persistent and widely aired myths in the industry’s campaign. As we heard from a current Trading Standards Officer on this very blog, “plain packs won’t encourage smuggling”.

The illicit cigarette market has been falling since its peak in the early 2000s, yet the tobacco industry claims the illicit trade is ‘booming’ (which a parliamentary report noted is “contrary to the available statistics”).

Even their representatives (the Tobacco Manufacturers Association) accept that the consumption of illicit tobacco in the UK is falling.

When you look at the whole package, this collaboration, and extent of this deception is like something out of a Hollywood script.

What happens next?

Although the Government missed the chance to announce standard packs in the Queen’s speech, there are still opportunities to introduce standard packs legislation in this session and let Parliament decide.

So we need to move fast. Email your MP today and ask them to do the right thing: introduce standardised cigarette packs and put the health of our children ahead of tobacco industry profits.

If all of us stand united in the fight against cancer, our voices will be louder and clearer than any campaign the tobacco industry can mount.

The irony of it all

The irony of this all is that shiny and glamorous branded tobacco packets are the perfect metaphor for the tobacco industry’s tactics throughout this campaign.

Their reports and websites look the part; they slap a logo on them, and spend huge amounts to promote them, to as wide an audience as possible. But when you open the page, much like opening a pack of cigarettes, all you find inside is a toxic concoction that flatters to deceive.

It is easy to be frustrated, agitated and angry with the government’s failure to back up a commitment to reducing preventable mortality, by ignoring a measure that will reduce the appeal of an addiction that causes one in every four cancer deaths in the UK.

In this regal speech, which laid out this government priorities, it appears that a supporting cast of tobacco industry proxies have won the day.

This stuttering progress can be overcome, and we will urge the government to ignore the profit-driven interests of the tobacco industry, and instead move to protect its most vulnerable citizens.

Ultimately, we think this is a policy for which they would be celebrated, resonating with the assured words of King George VI that ‘the highest of distinctions is service to others’.

• Email your MP now

Chris

• Chris Woodhall is a tobacco control officer at Cancer Research UK

Today, the Queen set out the Government’s priorities for the next year

This morning the Queen opened the third session of the 2010-15 Parliament with a speech in the House of Lords.

Her speech was written by the Government, and outlined its legislative agenda for the upcoming parliamentary session (which will last roughly a year).

And over the next couple of days, both Peers in the House of Lords, and MPs in the House of Commons will debate its contents.

Cancer Research UK takes a great interest in the Government’s plans, and how we think they will affect cancer patients and research into the disease.

So what are the key points for us from this speech?

The bad news

First, the bad news. Last week’s rumours have turned out to be true, and the Government has failed to put forward legislation to put tobacco products in standardised packaging.

This is extremely disappointing, and a sad day for the nation’s health.

You can read more about our campaign for this here, and we’ll be posting a more detailed reaction tomorrow.

The good news

In better news, we’re pleased to see the Government’s plans for a Care Bill. Although this is principally about care and support for those in older age, it contains clauses which should also improve the way research is carried out in the NHS.

We’ll be looking at the finer details as they emerge, but we’re hopeful that the Government has listened to the suggestions that we and others in the medical research community made,  to give new powers and independence to a body called the Health Research Authority (HRA).

Getting permission to run a study in a hospital continues to be one of the biggest barriers to doing research in the NHS, and is therefore a major issue for us at Cancer Research UK. At any one time we’re supporting around 240 clinical trials in the NHS.

In 2011, the Academy of Medical Sciences outlined in their report of NHS research governance the significant amount of time it took to recruit the first patient to a clinical trial. We do not believe that any great improvements have been made since that report.

We’ve been asking for several years for the approvals system in the NHS to be streamlined – there is evidence showing that many checks are duplicated or unnecessary at a local level.

In the HRA we see a great opportunity to deliver a big reduction in the time it takes to do a study, and we want the HRA to push forward with work to reduce this time, with support from the Government.

Making the HRA independent from Government will allow it to pursue its goals of promoting research in the NHS and protecting patients without having to worry about political interference. This will mean that the UK will have a much more stable and reliable regulatory system for health research.

You can read more about a recent Parliamentary inquiry where we discussed clinical trials here.

The Government also announced plans for a Mesothelioma Bill – which will establish a payment scheme for people with diffuse mesothelioma (a certain type of asbestos related lung cancer) where their employer or employers’ liability insurance company cannot be traced. There are around 3,500 people across the UK who qualify for payments, which will total around £355m in the first 10 years.

Next steps

Despite today’s disappointment, we will continue to push for the introduction of standardised tobacco packaging through our Setting the Standard campaign, particularly as we believe that support for the idea has a clear majority in Houses of Parliament. Tomorrow’s blog will go in to this in more detail, including how you can help.

On the HRA, we will look closely at the Government’s draft legislation, and continue to push for it to be the best it can be for cancer patients.

In all, the Government set out 20 new Bills today. As ever, we will be keeping a close eye on anything in these Bills that will affect cancer patients, and we’ll be campaigning on their behalf accordingly.

Simon.

It’s time for our round-up of the week’s headlines

• Breast cancer in women under 50 has reached 10,000 a year for the first time, according to figures we released this week. But the good news is that more women in this age group are surviving their disease. Here’s our press release, and the Telegraph’s front page coverage.