To try to spot patterns in cancer cases, survival and diagnosis, researchers study large groups of people – a field known as population research (or, more technically, epidemiology). They look for clues everywhere, from people’s genes and physical attributes, to their lifestyle, behaviour and medical history.
A prime example of this is the work of Sir Richard Doll, whose pioneering study of lung cancer patients in 1950 showed for the first time that smoking was a direct cause of the disease.
Doll and his team interviewed more than a thousand lung cancer patients, along with a comparable group of patients with other diseases, about their lifestyles – including their smoking habits. What emerged was a “significant, clear relationship” between smoking and lung cancer, and led directly to two 1960s reports – the US Surgeon General’s report and the UK Royal College of Physicians’ report.
These helped trigger a radical worldwide change in attitudes towards smoking, paving the way for anti-smoking legislation to help prevent lung cancer. So ultimately, their meticulous work linking smoking and cancer led to lower levels of smoking in the UK – and lung cancer rates have fallen as a result.
We’ve come a long way in our understanding of what influences the risk of developing cancer, but there’s still more to learn about the role our genes, behaviours and environment may be playing.
And with guidance from our Population Research Committee – a panel of experts, we have recently funded some innovative and exciting new projects, committing more than £1.6 million over the first year of research. Here are some highlights of the exciting science we’re supporting.
Predicting personal cancer risk
Dr Antonis Antoniou, University of Cambridge: amount for year one, around £380,000
Building on his previous work developing a computer programme called BOADICEA, which is widely used by healthcare professionals in the UK and around the world, Dr Antoniou is developing new ways of predicting cancer risk. These computer programmes will predict patients’ individual risk of developing certain types of cancer, including breast, ovarian and prostate. These powerful tools will bring together different factors which can increase a patient’s risk of developing these diseases, including genetic, hormonal, lifestyle, medical history and age.
This exciting new approach could help doctors tailor cancer screening better, and could identify people who might benefit from preventative measures such as hormone treatments.
A sponge to help diagnose Barrett’s oesophagus
Professor Rebecca Fitzgerald, University of Cambridge: amount for year one, around £400,000
Professor Fitzgerald and her team at the University of Cambridge have been developing a new test, called the cytosponge – a cell collection device coupled with lab tests on the cells – to diagnose a condition called Barrett’s oesophagus that increases peoples’ risk of developing oesophageal cancer.
The next stage of the test’s development is a clinical trial called BEST3, which will see it being tested in 84 GP surgeries around the UK. Each surgery will be randomly assigned to either follow the current procedure for managing patients with acid reflux, or to test the new cytosponge test.
The most common symptom of Barrett’s is persistent heartburn, and a procedure called an endoscopy is currently the only way to diagnose it. Because endoscopy is expensive, requires special training and can carry risk, it isn’t possible to offer to everyone who has heartburn. Professor Fitzgerald will be looking at whether introducing the cytosponge test, which is cheaper and easier than endoscopy could help diagnose Barrett’s.
They hope that by making Barrett’s oesophagus easier to diagnose, some oesophageal cancers will be detected and treated earlier, and possibly even prevented.
Detecting prostate cancer early in high risk men
Professor Rosalind Eeles, The Institute of Cancer Research: amount for year one, around £170,000
The trial is offering a blood test to men with certain faulty genes which put them at higher risk of developing and dying from prostate cancer. The test will measure levels of a molecule called PSA.
The team will offer annual PSA-based screening to these high-risk men over the course of five years. Any who are found to have high, or rapidly rising PSA levels will be offered a prostate biopsy to check for cancer. At the end of the study, all patients will also be offered a prostate biopsy. The aim is to find out if the PSA test was able to reliably indicate cases of prostate cancer in this group of high risk men.
They are hoping that targeting PSA testing to men who are at high risk of prostate cancer can help to ensure the disease is caught early, when treatment is more likely to be successful.
Life after cancer
Dr Christine Campbell, the University of Edinburgh: amount for year one, around £95,000
Dr Campbell’s project is looking at how cancer treatment can affect patients years later, including how it affects their chances of developing a second, different type of cancer, unrelated to their first diagnosis.
Dr Campbell will focus on how a having had a previous cancer diagnosis affects the way patients might be diagnosed a second time, including how it may affect doctors’ decisions, and how quickly patients report their symptoms. Her aim will be to find ways to ensure these tumours are diagnosed as early as possible, giving patients the best chance of survival.
Benefits and risks of cancer treatments
Professor Sarah Darby, University of Oxford: amount for year one, around £625,000
Professor Darby and her team at the University of Oxford are using patient data to improve the way cancer patients are treated in the clinic.
Some cancer treatments carry long-term risks of heart disease or developing a second cancer. For cancers where survival is good, doctors and patients face choices where they need to weigh up both the likely benefit and possible long-term harms of treatment options.
The Oxford team will use their findings to developing internet-based decision aids for early breast cancer and Hodgkin lymphoma. These will help doctors treating patients with these cancers weigh up the pros and cons of the various treatment options, helping doctors and patients to choose the best treatment for them.
Professor Darby is also studying the risk of heart disease caused by some cancer treatments, with the aim of helping doctors further improve the safety of radiotherapy.
We look forward to seeing how the results of these exciting studies will help us continue to identify more cancer risk factors, diagnose cancer earlier, and make treatments kinder – and ultimately, save more lives.
Helena Spooner, intern at Cancer Research UK