I have prostate cancer. But I am happy | George Monbiot

The three principles that define a good life will protect me from despair, says Guardian columnist George Monbiot

It came, as these things often do, like a gunshot on a quiet street: shocking and disorienting. In early December, my urine turned brown. The following day I felt feverish and found it hard to pee. I soon realised I had a urinary tract infection. It was unpleasant, but seemed to be no big deal. Now I know that it might havesavedmy life.

The doctor told me this infection was unusual in a man of my age, and hinted at an underlying condition. So I had a blood test, which revealed that my prostate-specific antigen (PSA) levels were off the scale. An MRI scan and a mortifying biopsy confirmed my suspicions. Prostate cancer: all the smart young men have itthisseason.

On Monday, I go into surgery. The prostate gland is buried deep in the body, so removing it is a major operation: there are six entry points and it takes four hours. The procedure will hack at the roots of my manhood. Because of the damage that will be caused to the surrounding nerves, theres a high risk of permanent erectile dysfunction. Because the urethra needs to be cut and reattached to the bladder, I will almost certainly suffer urinary incontinence for a few months, and possibly permanently. Because the removal of part of the urethra retracts the penis, it appears to shrink, at least until it can be stretched back into shape.

I was offered a choice: radical surgery or brachytherapy. This means implanting radioactive seeds in the parts of the prostate affected by cancer. Brachytherapy has fewer side effects, and recovery is much faster. But theres a catch. If it fails to eliminate the cancer, theres nothing more that can be done. This treatment sticks the prostate gland to the bowel and bladder, making surgery extremely difficult. Once youve had one dose of radiation, they wont give you another. I was told that the chances of brachytherapy working in my case were between 70 and 80%. The odds were worse, in other words, than playing Russian roulette (which, with one bullet in a six-chambered revolver, gives you 83%). Though I have a tendency to embrace risk, this was not an attractive option.

It would be easy to curse my luck and start to ask, Why me? I have never smoked and hardly drink; I have a ridiculously healthy diet and follow a severe fitness regime. Im 20 or 30 years younger than most of the men I see in the waiting rooms. In other words, I would have had a lower risk of prostate cancer only if I had been female. And yet I am happy. In fact, Im happier than I was before my diagnosis. How can this be?

The reason is that Ive sought to apply the three principles which, I believe, sit at the heart of a good life. The first is the most important: imagine how much worse it could be, rather than how much better.

When you are diagnosed with prostate cancer, your condition is ranked on the Gleason Score, which measures its level of aggression. Mine is graded at seven out of 10. But this doesnt tell me where I stand in general. I needed another index to assess the severity of my condition, so I invented one: the Shitstorm Scale. How does my situation compare to those of people I know, who contend with other medical problems or family tragedies? How does it compare to what might have been, had the cancer not been caught while it was still apparently confined to the prostate gland? How does it compare to innumerable other disasters that could have befallen me?

When I completed the exercise, I realised that this bad luck, far from being a cause of woe, is a reminder of how lucky I am. I have the love of my family and friends. I have the support of those with whom I work. I have the NHS. My Shitstorm Score is a mere two out of 10.

The tragedy of our times is that, rather than apply the most useful of English proverbs cheer up, it could be worse we are constantly induced to imagine how much better things could be. The rich lists and power lists with which the newspapers are filled, our wall-to-wall celebrity culture, the invidious billions spent on marketing and advertising, create an infrastructure of comparison that ensures we see ourselves as deprived of what others possess. It is a formula for misery.

The second principle is this: change what you can change, accept what you cant. This is not a formula for passivity Ive spent my working life trying to alter outcomes that might have seemed immovable to other people. The theme of my latest book is that political failure is, at heart, a failure of imagination. But sometimes we simply have to accept an obstacle as insuperable. Fatalism in these circumstances is protective. I accept that my lap is in the lap of the gods.

So I will not rage against the morbidity this surgery might cause. I wont find myself following Groucho Marx who, at the age of 81, magnificently lamented: Im going to Iowa to collect an award. Then Im appearing at Carnegie Hall, its sold out. Then Im sailing to France to pick up an honour from the French government. Id give it all up for one erection. And today theres Viagra.

The third principle is this: do not let fear rule your life. Fear hems us in, stops us from thinking clearly, and prevents us from either challenging oppression or engaging calmly with the impersonal fates. When I was told that this operation had an 80% chance of success, my first thought was thats roughly the same as one of my kayaking trips. And about twice as good as the chance of emerging from those investigations in West Papua and the Amazon.

There are, I believe, three steps to overcoming fear: name it, normalise it, socialise it. For too long, cancer has been locked in the drawer labelled Things We Dont Talk About. When we call it the Big C, it becomes, as the term suggests, not smaller, but larger in our minds. He Who Must Not Be Named is diminished by being identified, and diminished further when he becomes a topic of daily conversation.

The super-volunteer Jeanne Chattoe, whom I interviewed recently for another column, reminded me that, just 25 years ago, breast cancer was a taboo subject. Thanks to the amazing advocacy of its victims, this is almost impossible to imagine today. Now we need to do the same for other cancers. Let there be no moreterriblesecrets.

So I have sought to discuss my prostate cancer as I would discuss any other issue. I make no apologies for subjecting you to the grisly details: the more familiar they become, the less horrifying. In doing so, I socialise my condition. Last month, I discussed the remarkable evidence suggesting that a caring community enhances recovery and reduces mortality. In talking about my cancer with family and friends, I feel the love that I know will get me through this. The old strategy of suffering in silence could not have been more misguided.

I had intended to use this column to urge men to get themselves tested. But since my diagnosis, weve discovered two things. The first is that prostate cancer has overtaken breast cancer to become the third biggest cancer killer in the UK. The second is that the standard assessment (the PSA blood test) is of limited use. As prostate cancer in its early stages is likely to produce no symptoms, its hard to see what men can do to protect themselves. That urinary tract infection was a remarkably lucky break.

Instead, I urge you to support the efforts led by Prostate Cancer UK to develop a better test. Breast cancer has attracted twice as much money and research as prostate cancer, not because (as the Daily Mail suggests) men are the victims of injustice, but because womens advocacy has been so effective. Campaigns such as Men United and the Movember Foundation have sought to bridge this gap, but theres a long way to go. Prostate cancer is discriminatory: for reasons unknown, black men are twice as likely to suffer it as white men. Finding better tests and treatments is a matter of both urgencyand equity.

I will ride this out. I will own this disease, but I wont be defined by it: I will not be prostrated by my prostate. I will be gone for a few weeks but when I return, I do solemnly swear I will still be the argumentative old git with whom you are familiar.

George Monbiot is a Guardian columnist

Prostate Cancer UK can be contacted on 0800 0748383

Read more: https://www.theguardian.com/commentisfree/2018/mar/13/prostate-cancer-happy-diagnosis-operation

Spread of breast cancer linked to compound in asparagus and other foods

Using drugs or diet to reduce levels of asparagine may benefit patients, say researchers

Spread of breast cancer linked to compound in asparagus and other foods

Using drugs or diet to reduce levels of asparagine may benefit patients, say researchers

Read more: https://www.theguardian.com/science/2018/feb/07/cutting-asparagus-could-prevent-spread-of-breast-cancer-study-shows

How yoga could ease cancer patients’ pain and fatigue

Researchers in one study find patients who do yoga sleep less but are less tired, while another study sees mood benefits among those who add yoga to exercise

Yoga may help ease the pain and fatigue of cancer treatment, according to new research.

One study conducted at the University of Rochester used two surveys to interrogate why a group of about 300 mostly female cancer patients felt less fatigued following a program of yoga.

Researchers found patients who practiced yoga slept less but had less fatigue, in large part because they cut down on daytime napping. The result was a 37% reduction in daytime dysfunction, the studys most dramatic finding.

We recommend that doctors prescribe this low-risk, low-cost treatment to all cancer patients with cancer-related fatigue, said Po-Ju Lin, a researcher from the University of Rochester Medical Center in New York, who presented one of the studies at the American Society of Clinical Oncology in Chicago.

We would like them to prescribe gentle hatha yoga but they need to refer to appropriate yoga instructors who have experience of working with cancer patients.

In another study presented at ASCO, researchers at the Tata Memorial Centre in Mumbai, India, compared programs of yoga and conventional exercise to conventional exercise alone in an effort to find out if yoga improved quality of life for a group of more than 600 women with breast cancer.

After a year and a half of follow-up, researchers found patients who practiced both yoga and exercise were nearly twice as likely to report improved mood, 34% versus 66%, and had less trouble with general activities, 41% versus 59%.

The principal investigator in the second study said scientists believe that a reduction in cortisol, sometimes called a stress hormone, could account for the improved well-being among patients.

Yoga works on the principle of mind and body health and it would help women cope with systemic therapy side effects better, said Nita Nair, an associate professor of surgical oncology at Tata Memorial Centre and lead investigator. Yoga nidra and pranayama also improve sleep patterns. Thus all this together may reduce fatigue and pain.

In general, research on ways to ease fatigue falls into three main categories, said William Breitbart, a psychiatrist at Memorial Sloan Kettering Cancer Center in New York who focuses on pain and cancer patients and was not involved in the study. Those areas of research are: mitigating physiological side effects such as anemia, prescribing drugs such as amphetamines, and recommending exercise programs such as yoga.

If you actually look at the scientific literature, most of the effective therapies look at the last group of interventions, said Breitbart treatments such as cognitive behavioral therapy, and more recently interventions like exercise, tai chi and yoga.

Read more: https://www.theguardian.com/science/2017/jun/07/yoga-cancer-patients-pain-fatigue

Simple way to boost cancer survival rates: diet and exercise, studies say

Studies of colon and breast cancer patients link healthy habits to better outcomes amid slew of research on lifestyle and cancer

A healthy diet and exercise could reduce colon cancer patients chance of death and simply walking could improve survival rates for breast cancer survivors, studies presented at the worlds largest cancer conference have found.

A study of nearly 1,000 colon cancer patients found that those who exercised regularly, ate more fruits and vegetables and avoided refined grains and meats had a 42% lower chance of death after seven years.

Similarly, a study of more than 300 Australian breast cancer survivors who aimed to exercise for 180 minutes per week most by simply walking had far better rates of survival than those who were not part of an exercise program.

The studies were presented amidst a slew of research on the impact of a healthy lifestyle on cancer, presented at the American Society of Clinical Oncology (ASCO) in Chicago.

Most of what we know about the importance of exercise post-cancer comes from studying women with breast cancer, said Sandra Hayes, an epidemiologist studying cancer and exercise at Queensland University of Technology in Australia.

Studies conducted on the relationship between exercise and other types of cancer, she said, held up a general set of findings.

Engaging in some activity [or] exercise is better than none, and doing more is generally better than less, Hayes said.

Researchers acknowledged that studies on the effects of exercise and cancer recurrence remain epidemiological, and that causal links are yet to be established. Further, the mechanisms through which exercise may influence cancer survival remain unclear.

In one study, researchers at the University of California San Francisco and colleagues aimed to test whether American Cancer Society (ACS) nutrition and exercise guidelines for cancer survivors could impact survival among colon cancer patients.

In general, the guidelines recommend moderate exercise of 150 minutes per week, eating a diet rich in whole grains, fruits and vegetables, and keeping a healthy body weight. The ACS has detailed guidelines for nutritional and exercise standards for cancer survivors, addressing everything from exercise to eating recommendations forthose who have little appetite.

Researchers found that even colon cancer survivors who drank moderately while following other guidelines had a 42% lower chance of dying than those that did not.

I would recommend that patients build up to exercising for at least 150 minutes per week, said the senior author, Erin Van Blarigan, an epidemiologist at University of California San Francisco. Brisk walking is a great exercise for everyone. I would also recommend that patients aim to eat at least five servings of vegetables every day, not counting potatoes, and choose whole grains over refined grains.

Van Blarigan said she was surprised by the strong correlation between healthy diet, exercise and lowered mortality.

These recommendations can be applied within whatever diet type an individual prefers, she said. The key is finding foods that fit the recommendations that you enjoy, so you can continue this pattern of eating for the long term.

In a smaller study, Hayes and colleagues in Australia randomly assigned more than 300 breast cancer survivors to groups that received exercise counseling or to a control group.

All patients were six weeks out of surgery, and lived in both rural and urban settings. The exercise program lasted eight months. The goal was to exercise 180 minutes per week. Most of the participants, researchers said, chose simply to walk.

After a median follow-up of roughly eight years, researchers found 5.3% of the women who had received exercise counseling had died, versus 11.5% of those who had not received counseling. Similarly, 12.1% of women in the group that received exercise counseling had a recurrence of cancer, versus 17.7% of those who did not.

The researchers said an exercise program after treatment has clear potential to influence survival.

Read more: https://www.theguardian.com/science/2017/jun/04/breast-cancer-colon-survival-rates

Painless cancer detection could become routine thanks to ‘liquid biopsies’

Biopsies are seen as the best way of detecting the illness but they have traditionally often required invasive techniques

Researchers are developing tests that could make cancer detection so painless that it becomes part of routine check-ups, experts said, as new developments in such liquid biopsy technology were presented at the worlds largest cancer conference in Chicago this weekend.

Collecting tumor tissue through biopsies is considered the gold standard for diagnosing and treating cancer. However, necessary surgery is often invasive and sometimes unsuccessful.

That has fueled interest in technology that uses blood samples to examine bits of DNA shed into the bloodstream by tumors. The hope, researchers say, is to save patients the pain of surgery, monitor tumor growth to tailor treatment, and ultimately to save lives.

Its fair to say that if you could detect all cancers while they are still localized, you could diminish cancer deaths by 90%, said Dr Bert Vogelstein, a professor of oncology at Johns Hopkins School of Medicine who co-authored a study presented at the American Society of Clinical Oncology (ASCO) in Chicago.

But thats a theoretical figure. The available data suggests that its going to take quite a while, and there are a lot of obstacles to overcome.

Like all cells, cancerous cells shed DNA as they die. Tests in development examine these bits of DNA in the bloodstream, finding mutations in already diagnosed cancers or, experts hope, diagnosing cancer early.

Part of the challenge in developing such tests is scale. Pieces of DNA represent a tiny portion of a blood sample. Pieces of cancer DNA represent an even tinier sliver of all the DNA present in blood.

Pieces of genetic material, called cell-free DNA, are found in blood plasma. But plasma contains cell-free DNA from all over the body not just cancer. In some cases, cell-free DNA from cancer represents just 0.1% of all cell-free DNA, new research has found. That makes the search a needle in a haystack.

One of the studies presented at ASCO sequenced 100 times more data than ever before. Using such high-intensity sequencing, researchers from Memorial Sloan Kettering Cancer Center scanned regions of the genome up to 60,000 times to look for 508 specific genes.

Dr Pedram Razavi and his research team collected blood samples from 124 patients with metastatic breast, non-small cell lung or prostate cancer. Biopsies were collected to provide a baseline, and researchers also sequenced each patients white blood cells to rule out benign mutations.

In 89% of the patients, researchers identified at least one gene mutation. The highest success rates were for breast cancer patients, in whom researchers were able to find 97% of gene mutations.

Ravazi said simple tests to screen for cancer were a very long way from development, but the new research brought doctors one step closer. This is a promising first step in patients with metastatic DNA, he said, referring to advanced cancer patients.

Another abstract presented at ASCO took the opposite approach. US and Australian researchers at Johns Hopkins and the Walter and Eliza Hall Institute of Medical Research in Melbourne screened 119 pancreatic cancer patients for just one mutation found nearly all pancreatic cancers.

Though only four patients had advanced cancer, researchers found cell-free DNA in all of them. In patients with stage two cancer, the largest group, researchers found cell-free DNA in 54.5% of 99 cases. Authors said tests showed promise for screening, and could help guide treatment.

One of the researchers, Peter Gibbs, said he could envision that within five years, people would receive tests that search for about 20 cancer gene mutations.

Its potentially very close by, said Gibbs. The potential impact on screening and prevention is huge.

Read more: https://www.theguardian.com/science/2017/jun/04/cancer-detection-liquid-biopsies

Trial finds combination of pancreatic cancer drugs extends survival

Campaigners hail monumental leap forward in treatment of most lethal form of cancer, which kills 8,800 Britons each year

Cancer campaigners are hailing a monumental leap forward in pancreatic cancer treatment after a new drug trial significantly extended survival from what is the most lethal form of the disease.

The clinical trial found that 29% of patients given a combination of two chemotherapy drugs lived for at least five years compared with 16% who received the one chemotherapy drug that is still the NHSs standard treatment.

The results are important because they could lead to an improvement in the prospects for people who develop pancreatic cancer, which has the lowest survival rates among the 21 most common forms of the disease and kills 8,800 Britons a year. Only one in 100 people survive for 10 or more years after their diagnosis.

These results are a monumental leap forward in pancreatic cancer treatment. We believe this could herald a true step change in the treatment of this tough cancer, offering substantially more patients who have had surgery the chance to live for longer and, crucially, without significant added side-effects, said Leanne Reynolds, head of research at the charity Pancreatic Cancer UK.

About 10,000 people are diagnosed with pancreatic cancer each year in the UK. However, the apparent breakthrough may only benefit the 800 who have surgery. The cancer is too advanced in most of the other 9,200 cases for surgery to be worthwhile.

Four in five patients are only diagnosed when the cancer has reached an advanced stage, and in 46% of cases only after they have presented as an emergency at an A&E unit. Survival rates have barely improved for 40 years, in contrast to some other forms of the disease. It is the fifth most common cause of cancer death in the UK.

The ESPAC-4 (European study group for pancreatic cancer) trial involved 732 patients from 92 hospitals in England, Scotland, Wales, Germany, France and Sweden. Of those given both gemcitabine and capecitabine, 28.8% survived for at least five years, compared with just 16.3% who received only gemcitabine.

Pancreatic Cancer UK and the researchers behind the findings are now urging the NHS to replace gemcitabine with the combination as the standard treatment for the one in 12 sufferers of the disease who undergo a resection of their pancreas.

This is one of the biggest ever breakthroughs prolonging survival for pancreatic cancer patients, said Prof John Neoptolemos of Liverpool University, who lead the team of researchers.

When this combination becomes the new standard of care it will give many patients living with the disease valuable months and even years. The two drugs taken together extend median overall survival from 25 and a half months for those on gemcitabine alone to 28 months, according to the study, which has been published in the Lancet.

Cancer survival rates in England and Wales

The difference in short-term survival may seem modest, but improvement in long-term survival is substantial for this type of cancer, added Neoptolemos.

Meanwhile, separate research has also brought good news about lung cancer, which has the second worst survival rates among the commonest forms of cancer.

The number of people surviving for at least a year after diagnosis rose from 31% to 38% between 2010-2015, according to the NHSs latest audit of the quality of care patients receive. Experts in the disease welcomed the increase, which is mainly the result of earlier diagnosis.

Ian Woolhouse, the audits senior clinical lead, said it was very encouraging that one-year survival had improved in what is the UKs second most common form of cancer after breast cancer.

His team noted other progress too in how the NHS treats patients, including the fact that 60% of patients now receive some for of anti-cancer treatment. They analysed the records of 43,000 people diagnosed with lung cancer in 2015.

However, they voiced concern about the persistent wide and unacceptable variation in standards of care provided by NHS trusts and boards across England, Wales, Scotland and Guernsey. Only 57% of patients are seen by a specialist lung cancer nurse, for example, even though the target for that is 90%.

Dr Jesme Fox, medical director of the Roy Castle Lung Cancer Foundation, said: We are pleased to see this encouraging increase in patient survival. However, there is much still to do to ensure that lung cancer patients are diagnosed as early as possible and are able to access best practice treatment and care.

Read more: https://www.theguardian.com/science/2017/jan/25/pancreatic-cancer-drugs-trial-combination-extends-survival

Laser-activated drug a ‘leap forward’ for prostate cancer treatment

New therapy does not cause side-effects such as impotence and urinary incontinence, researchers say

A drug activated by laser light successfully destroys early prostate cancer while avoiding side-effects that commonly occur with surgery, trial results have shown.

The new technique, called vascular-targeted photodynamic therapy (VTP), involves injecting a light-sensitive drug into the bloodstream. The drug is then switched on by laser pulses fired through optical fibres inserted into the prostate.

Of 196 men who received the treatment, about half showed no signs of the disease two years later, compared with 13.5% of those given standard care.

Because VTP targets only prostate tumours, it does not cause the long-term problems of impotence and urinary incontinence often associated with radical surgery or radiotherapy.

Lead investigator Professor Mark Emberton, consultant urologist at University College London hospital, said: These results are excellent news for men with early localised prostate cancer, offering a treatment that can kill cancer without removing or destroying the prostate.

This is truly a huge leap forward for prostate cancer treatment, which has previously lagged decades behind other solid cancers such as breast cancer.

In 1975, almost everyone with breast cancer was given a radical mastectomy, but since then treatments have steady improved and we now rarely need to remove the whole breast.

In prostate cancer, we are still commonly removing or irradiating the whole prostate, so the success of this new tissue-preserving treatment is welcome news indeed.

Currently, men with low-risk localised prostate cancer are put under active surveillance, which means monitoring the disease but providing no treatment unless it becomes more severe.

In the trial consisting of 413 men, participants were randomly assigned either to VTP or active surveillance.

Only 6% of the VTP group later needed radical treatment, compared with 30% of active surveillance patients. VTP treatment also doubled the average time of cancer progression from 14 months to 28 months.

The trial, reported in the Lancet Oncology journal, was conducted across 47 treatment sites in 10 European countries, most of which were performing VTP for the first time.

Emberton said: The fact that the treatment was performed so successfully by non-specialist centres in various health systems is really remarkable.

New procedures are generally associated with a learning curve, but the lack of complications in the trial suggests that the treatment protocol is safe, efficient and relatively easy to scale up.

We would also expect the treatment to be far more precise if we repeated it today, as technology has come a long way since the study began in 2011.

We can now pinpoint prostate cancers using MRI (magnetic resonance imaging) scans and targeted biopsies, allowing a much more targeted approach to diagnosis and treatment.

This means we could accurately identify men who would benefit from VTP and deliver treatment more precisely to the tumour.

With such an approach, we should be able to achieve a significantly higher remission rate than in the trial and send nearly all low-risk localised prostate cancers into remission.

We also hope that VTP will be effective against other types of cancer. The treatment was developed for prostate cancer because of the urgent need for new therapies, but it should be translatable to other solid cancers including breast and liver cancer.

The drug used, WST11, is derived from bacteria at the bottom of the ocean. To survive with very little sunlight, the bugs have evolved to convert light into energy with high efficiency. This property was exploited to develop the drug, a compound that releases destructive tumour-busting free radical molecules when activated by laser light.

Gerald, a man aged in his 60s from Surrey, was one of the first patients to be treated with VTP under the care of Emberton.

He said: The treatment … changed my life. Im now cancer-free with no side-effects and dont have to worry about needing surgery in future. I feel so lucky to be in this position.

Ive met other men who had surgery – they had to stay in hospital for days whereas I could go home the next day, and one suffered from terrible incontinence which he found very distressing.

I had some minor side-effects for a few weeks after the operation, but Im back to normal now.

Each year, more than 46,000 men in the UK are diagnosed with prostate cancer and 11,000 die from the disease.

Read more: https://www.theguardian.com/society/2016/dec/20/prostate-cancer-treatment-laser-activated-drug-a-leap-forward

‘Angelina Jolie effect’ boosted genetic testing rates, study suggests

Actors call for women to seek testing for breast and ovarian cancer mutations raised screening rates but may not have reached those most at risk

Angelina Jolies revelation that she underwent a double mastectomy to reduce her chances of developing breast cancer boosted rates of genetic testing among women, but might have failed to reach those most at risk, new research suggests.

In a 2013 article for the New York Times, Jolie explained her decision to undergo a double mastectomy after finding that she had a mutation in a gene known as BRCA1 that greatly increased her risk of breast and ovarian cancers.


I am writing about it now because I hope that other women can benefit from my experience, she wrote. Cancer is still a word that strikes fear into peoples hearts, producing a deep sense of powerlessness. But today it is possible to find out through a blood test whether you are highly susceptible to breast and ovarian cancer, and then take action. After surgery her risk of developing breast cancer in later life fell from 87% to 5%.

The actors decision to tell her story was welcomed by medical experts and campaigners worldwide. But did women heed Jolies call?

Writing in the British Medical Journal, Sunita Desai and Anupam Jena of Harvard Medical School describe how they sought to answer the question by scrutinising data on US health insurance claims from more than nine million women aged between 18 and 64 .

These revealed that in the 15 working days following Jolies article, daily rates of testing for harmful mutations in BRCA1 and BRCA2 genes rose by 64%, compared with the 15 working days before. After six months, average monthly testing rates were still 37% higher than in the four months before the articles publication.

But the study also reveals that while genetic testing rates increased, there was no change in average, overall mastectomy rates in the six months following the articles publication and showed a slight drop in mastectomy rates among those who had BRCA tests.

The fact that mastectomy rates dropped after Angelina Jolies editorial suggests that that denominator of women who started getting the BRCA test became less appropriate for the BRCA test because they had a lower pre-test probability of having the mutation in the first place, said Desai.

However, Douglas Easton, professor of genetic epidemiology at the University of Cambridge, noted that the study did not offer insights into the BRCA test results meaning it was not possible to say whether women taking the test received negative results, or whether they had tested positive, but decided not to undergo surgery.

But Jennifer Litton, associate professor in the department of breast medical oncology at the University of Texas, said the results reflected what had been seen in clinics.

The Jolie effect was real, and we did have many more breast cancer patients ask about the test, she said. As only a small proportion of breast cancer patients harbour an abnormal gene, those that met national guidelines for testing had already had testing, so it did not change that group with the highest risk of a positive test.

The research is not the first to explore the impact of Angelina Jolies declarations, although previous UK-based studies found that both testing among women at risk, and subsequent preventative surgery, increased.

A co-author of the UK-based research, Tony Howell, professor of medical oncology and director of scientific research at Prevent Breast Cancer, says the new US study looked at too short a period after publication of Jolies article to truly reflect its impact. It takes weeks or months to get through the testing process in proper centres, he said. Same applies to risk-reducing breast surgery. This takes one to three years to filter through to surgery if all the checks and counselling are performed properly.

Overall, says Howell, the 2013 article was valuable in raising awareness. Jolie did a terrific job, he said.

Read more: https://www.theguardian.com/science/2016/dec/14/angelina-jolie-effect-boosted-genetic-testing-rates-study-finds-breast-ovarian-cancer

Cancer deaths among women to rise 60% by 2030, new reports warn

American Cancer Society and Lancet studies point to devastating increases, mostly in poorer countries, with breast cancer diagnoses set to almost double

Two reports have warned of an explosion in cancer deaths among women, with a toll, mainly from breast cancer, of around 5.5 million a year by 2030 roughly the population of Denmark.

This represented a near 60% increase in less than two decades, said an analysis conducted by the American Cancer Society (ACS), released on Tuesday at the World Cancer Congress in Paris.

As the global population grows and ages, the highest toll will be among women in poor and middle-income countries, it said, and much of it from cancers which are largely preventable.

Most of the deaths occur in young and middle-aged adults, placing a heavy burden on families and national economies, said Sally Cowal, senior vice-president of global health at the ACS, which compiled the report with pharmaceutical company Merck.

A second report, published in the Lancet medical journal on Wednesday, said the number of women diagnosed with breast cancer alone could almost double to 3.2 million a year by 2030 from 1.7 million in 2015.

For cervical cancer, the number of diagnoses could rise by at least 25% to over 700,000 by 2030, mainly in low- and middle-income countries, said a statement from the Lancet.

Cancer is already killing one in seven women around the world, said the ACS report the second highest cause of death after cardiovascular disease.

All four of the deadliest cancers breast, colorectal, lung and cervical cancer are mostly preventable or can be detected early, when treatment is more successful.

In poorer countries, a much smaller proportion of cancer cases are diagnosed and treated than in rich ones, while a much bigger group dies. The relative burden is growing for developing countries as people live longer due to better basic healthcare.

Women in these countries are also increasingly exposed to known cancer risk factors associated with rapid economic transition, said Cowal, such as physical inactivity, unhealthy diet, obesity, and reproductive factors including postponing motherhood.

Due to these changes, cancers that were once common only in high-income countries are becoming more prevalent, said the report entitled The Global Burden of Cancer in Women.

Read more: https://www.theguardian.com/society/2016/nov/02/cancer-deaths-women-rise-warning-lancet

We could prevent millions of cancer deaths with knowledge we already have | David Hunter

Cutting-edge breakthroughs are still vital in medicine, but we have many ways to prevent and cure cancer that arent globally accessible but should be

Vice-President Joe Bidens Cancer Moonshot Blue Ribbon Panel has released 10 recommendations to accelerate a new national effort to end cancer as we know it. These initiatives, focused mainly on the US, will almost certainly extend the lives of some cancer patients in the future.

However, cancer deaths worldwide are estimated to increase by over 50% between 2015 and 2030, mainly due to expanding and ageing populations. We already have the knowledge and technology to reduce this toll for future decades without waiting for new breakthroughs.

About half of cancer cases and deaths worldwide are preventable. For instance, lung and liver cancer are the most common causes of cancer deaths around the world and cervical cancer is the fourth leading cause among women. And we already know how to prevent almost all of them.

Like many of my colleagues who study cancer prevention, I believe that scaling up existing preventive interventions and already available treatments over two to three decades could save millions of lives around the world.

Cut the number of lung cancer deaths globally

Lung cancer is the most common cause of cancer death in the US and around the world, killing over 1.5 million men and women a year. But in American men, lung cancer death rates have fallen by about 40% over the past 25 years. In women, lung cancer rates have peaked.

Thats because the proportion of adults in the US who smoke has decreased by about 50% since the 1960s, due to public education, indoor smoking bans and higher prices due to higher tobacco taxes. This reduction happened despite the ongoing, vigorous efforts of tobacco companies to combat these public health initiatives.

Similar reductions in France and South Africa have been achieved by increasing cigarette prices. However, the number of smokers is still increasing in countries such as China and Indonesia as tobacco companies seek new markets, and a demographic bulge of younger potential smokers enters adolescence.

The World Health Organization Framework Convention on Tobacco Control is the international blueprint on policies to reduce the uptake of smoking and encourage current smokers to quit.

The United States is one of only seven countries that has signed but not ratified the Framework Convention on Tobacco Control. If our country is serious about cancer control, we should join the 180 countries that have ratified the convention.

Liver cancer: focus on vaccines and curing hepatitis C infections

Liver cancer is the second most common cause of cancer death worldwide, killing about three-quarters of a million people. It is the fifth most common cause of cancer death in the US.

The most common causes of liver cancer are infection with hepatitis B or hepatitis C virus. In some countries the dietary contaminant aflatoxin, produced by molds that grow on stored grains or nuts, exacerbates the risk that hepatitis B infection will cause liver cancer.

Hepatitis B infection is almost entirely preventable by vaccination in infancy. In fact, an 80% decline in liver cancer rates has been observed in Taiwanese birth cohorts that have received the vaccination early in life.

While rates of infant hepatitis B vaccination are high around the world, many babies are still missing out. Universal vaccination would lead to a further decline in liver disease and liver cancer globally.

Hepatitis C causes about a quarter of liver cancer deaths worldwide. Curative therapies like the new drug Sovaldi may be another tool to prevent liver cancer. Researchers think that curing patients of their hepatitis C infection will prevent them from going on to develop liver cancer.

But the current cost of these drugs is a substantial barrier to their use in both lower-income countries and in the US.

However, in Egypt, public-private partnerships have made the drugs available at less than 1/100th of their price in the United States. A vigorous international effort to use these new drugs to lower the number of infections would have a substantial impact on liver cancers caused by hepatitis C.

Heavier alcohol drinking also increases the risk of liver cancer (as well as cancers of the breast, esophagus, pancreas, colon and rectum). According to the World Health Organization consumption has been increasing in the two most populous countries, India and China.

Cervical cancer: vaccines and Pap smears

Cervical cancer kills more than 250,000 women a year worldwide, making it the fourth-leading cause of cancer death among women. In the US, however, it is 14th. From 1975 to 2012, the incidence of cervical cancer in the US decreased by half, due to Pap smear tests screening and removal of precancerous lesions.

However, almost all cases of cervical cancer are due to infection with the Human Papillomavirus (HPV), and we now have a vaccine against the main strains of HPV. In theory, cervical cancer is almost entirely preventable if HPV vaccination before the onset of sexual activity is followed by screening in adulthood to detect precancerous lesions caused by virus strains not covered by the vaccine. Yet the vaccine is not available to most girls in the world.

The World Health Organizations Expanded Program on Immunization ensures that 85% of the worlds young children now receive at least DPT vaccine against diptheria, pertussis and tetanus. This program created new distribution channels for vaccine and could be a model for increasing the number of prepubertal girls who receive the HPV vaccine.

Making sure that more women around the world receive the decades-old Pap smear testing or introducing the new HPV tests would also help reduce cervical cancer incidence.

We can also tackle childhood leukemia and breast cancer

In developed countries, the most common form of childhood leukemia, acute lymphocytic leukemia, is cured by conventional chemotherapy in over 80% of affected children. These life-saving, relatively inexpensive drugs have been available in the US for decades. Yet in other parts of the world, most children with leukemia die because they do not receive treatment.

Drugs like Tamoxifen and aromatase inhibitors have decreased mortality from estrogen-fueled breast cancers in the developed world. Yet most women in the developing world with these cancers do not receive these inexpensive medications.

While leukemia and breast cancer require relatively sophisticated diagnostic and treatment infrastructure, they dont require new treatments. The still-missing piece is the political will and funding to expand access to these long-established treatments.

Optimizing the technology and knowledge we already have

Pinning our hopes on new technologies isnt the only way to reduce cancer deaths worldwide. A moonshot-level impact could be guaranteed just by ensuring the interventions and treatments we already know to be effective are deployed around the world.

Critically, we already have models that show how this can be done. Programs, such as the Presidents Emergency Fund for Aids Relief and the Global Fund for HIV, TB and Malaria made lifesaving antiretroviral drugs available to millions of HIV patients by negotiating much lower drug prices. The programs also helped countries establish the necessary infrastructure to deliver the drugs and monitor patients.

There is much more we can do to prevent cancer in the US. Although smoking rates have done down, 17% of adults still smoke. Less than half of our teenage girls and boys received the recommended three doses of the HPV vaccine. Racial disparities still exist in access to early detection and treatment of cancers.

For the cancers we cannot prevent, we will always need new and better therapies. But we should not wait for future cures to do what we can to prevent cancer deaths around the world.

We can choose to prevent many cancers and cancer deaths globally. In the words of President John F Kennedy in launching the first moonshot:

because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone.

This story first appeared on The Conversation.

Read more: https://www.theguardian.com/commentisfree/2016/oct/17/prevent-millions-of-cancer-deaths-with-knowledge-already-have