Chasing the cure

STEPHEN LEWIS reports, while MAXINE GORDON speaks to a survivor.

A CURE for cancer has been the Holy Grail of medical research for decades. If we have learned anything during the past 30, 40 or 50 years, it is this: there is not going to be one stunning breakthrough which banishes the disease.

Cancer occurs in too many different forms, it affects too many different parts of the body, and it has too many different causes for the battle to be anything but a long, hard one - a war of steady, small victories.

Nevertheless, new figures released by Cancer Research UK - which provide a snapshot comparison of cancer survival rates today compared with 30 years ago - offer hope.

The number of people dying from cancer every year in the UK today is 12 per cent lower than in 1972.

Given the decades of technological and scientific advance we have seen, and the leap forwards made in understanding how our lifestyle contributes to our risk of developing cancer, that may not seem a huge advance.

Yet that fall in deaths comes even though we are living longer and far more people are being diagnosed with cancer than before.

In that context, stresses Professor Norman Maitland, head of the Yorkshire Cancer Research (YCR) cancer research unit at York University, a 12 per cent fall in deaths from cancer in 30 years represents a major advance.

"We're doing really rather well," he says. "It is very positive news."

Not unreservedly good news. Our progress in tackling cancer has been patchy at best.

In some areas there have been spectacular successes. In the last generation, the number of people dying from stomach cancer has more than halved. Deaths from bowel cancer are down 35 per cent and from Hodgkins Disease (a cancer of the lymphatic system) 74 per cent.

During the same period, the number of women dying from breast cancer has fallen by 20 per cent, and the number of men dying from testicular cancer by 37 per cent.

There are failures as well as successes.

While the number of men dying from lung cancer has fallen by nearly half, the number of women dying from the same disease has increased by 55 per cent. It is a grim reminder of how our own behaviour can affect our health.

The change in death rates from lung cancer for men and women is almost entirely due, experts say, to our smoking habits. Since the 1960s and 1970s many men have given up smoking. Many women, during the same period of time, have taken it up. There could be no clearer indication of the fact that smoking kills.

Overall, scientists are pleased with the progress made in fighting cancer, but stress that there remains a long way to go.

"We understand so much more about the disease now than we did a generation ago," says Professor Peter Selby, director of the Cancer Research UK Unit at St James's Hospital in Leeds.

"The introduction of screening and improvements in chemotherapy during the last generation has had a huge effect. There are still many cancers that are very difficult to treat successfully. But unravelling the disease opens up more and more avenues for the development of new methods of preventing, treating and curing cancer."

So what have been some of the main successes and failures of the past 30 years? And what does the future hold?

Lung cancer among men

There are still more men dying from lung cancer than women, but that is because historically men smoked far more. "After the war, something like eight out of ten men smoked, and smoked heavily," Prof Maitland says. "Now, the number of men smoking has gone down." That is reflected in the dramatic fall in the numbers of men dying from the disease.

Stomach cancer

This is another example of the way in which lifestyle can dramatically affect our likelihood of dying from cancer. Deaths from stomach cancer are down by 65 per cent among men, and 70 per cent among women, Prof Maitland says - and much of that is due to changes in our eating habits. In the past, we ate far more salted and preserved foods; today, with the advent of fridges, we eat more fresh food.

Bowel cancer

There has been a surprising drop in people dying of bowel cancer, Prof Maitland says, especially because with people now living longer, more people develop the disease. Most of the success is put down to improvements in bowel cancer surgery as a result of surgeons specialising in the condition. Changes to a higher fibre diet may also have helped.

Testicular cancer

Death rates are down, partly as a result of improvements in treatment, but also because of greater awareness among young men of the need to check themselves regularly, Prof Maitland says. The example of jockey Bob Champion may well have helped.

Lung cancer among women

Death rates are sharply up, in stark contrast with death rates among men. Again, it is down to smoking.

"In previous ages it was socially unacceptable for women to smoke," says Prof Maitland. "Now it is almost expected of them, as a result of peer pressure and the desire of young women to look older and more sophisticated."

The result is a time-bomb. There is generally a 20-year time lag between a mass change in behaviour such as more women taking up smoking, and the figures for death or survival rates from lung cancer. More women began to smoke in the 1970s and 1980s, and we're now beginning to see the effect of that in the statistics. But there could be worse to come.

Prostate cancer

Death rates have increased by a third since the 1970s, although this may well be due largely to men living longer.

"It is a disease that affects older men," Prof Maitland says. "Fewer men are dying of lung cancer or of heart disease, so lots of men now live to the age when they can develop prostate cancer. And while we know what causes lung cancer and stomach cancer, we don't know what causes prostate cancer, apart from being male and old."

Skin cancer

(malignant melanoma)

Death rates are sharply up, among men and women. This, says Ruth Yates of Cancer Research UK, is probably because of our sun-worshipping culture. Treatments and survival rates among those who develop the cancer are improving, however - otherwise the death rates would be even worse.

Medical research is offering exciting possibilities, says Prof Maitland.

Prostate cancer

At York, research is concentrating on prostate and cervical cancer. With prostate cancer, the key is in detecting the disease early, when it is readily treatable.

In the later stages, when it spreads out beyond the prostate itself into other areas of the body, the disease becomes much harder to treat.

Researchers at York are trying to find out why the disease spreads, to see if ways can be found to stop it doing so.

The search is also on for new, more effective ways of killing the cancer, such as gene therapy.

Cervical cancer

Some cancers, such as cervical cancer, are thought to be caused by a virus. Researchers are looking at ways of immunising people against the virus, so preventing the disease from developing. Ultimately, Prof Maitland says, it may be possible to immunise girls at a fairly young age (before pubescence).

Cancer vaccinations

A number of anti-cancer vaccines are already being tested, which may be effective against cancers of the kidney, prostate, breast and skin.

These vaccines would effectively work by activating the body's own immune system against cancers, says Prof Maitland.

The immune system does not generally attack cancer cells because it assumes they are part of your own body.

The vaccine would effectively wake the immune system up to the presence of the cancer cells, so it would start attacking them.

Vaccines could only be given once a cancer has been diagnosed, Prof Maitland stresses - and would not work for everyone. But it is a promising area of research.

Look at me. I'm four years down the line

YORK mum-of-two Valerie Flower was 39 when she suspected she might have breast cancer.

"My son was cuddling up to me and I suddenly felt something in my right breast," she recalls. "I went to my GP straight away and within a week I had a letter to attend the one-stop breast clinic at York Hospital."

The following week, Valerie saw a cancer specialist and had a biopsy, where a small needle was inserted into the suspicious lump to withdraw cells which were sent away for analysis.

"You get the result that same day," says Valerie. For her, it was the news she feared. "They took me to one side, sat me down and said it was cancer, but it was treatable."

She was told she would need a mastectomy followed by chemotherapy.

Despite being a hospital nurse, Valerie was frightened and anxious about what lay ahead. But she was reassured by how quickly her treatment was moving along.

Within a week, she was back in hospital for the operation. She had four months of chemotherapy and was prescribed the drug Tamoxifen, to prevent the cancer returning. She has annual mammograms and four years on is still free of the disease.

Valerie is only too aware that she has benefited from the results of years of painstaking and expensive cancer research. A generation ago, her story might not have had a happy ending.

She is also full of praise for the speedy and professional service offered by cancer medics in York.

"The breast cancer care nurses are absolutely brilliant and are with you all the way. I'm sure it helped that I was treated so quickly too."

She added: "Cancer care has come on leaps and bounds. I think we do need to put more money into it. There has been so much progress in the past few years that we must be very close to finding a cure.

"People should do their bit in terms of raising money for charities but I also think there should be more funding from Government."

Valerie does her bit. Since her diagnosis, she has taken part in the annual Race For Life on York's Knavesmire, which raises funds for cancer research.

She believes that people's attitudes to cancer are changing. Instead of fearing the worse, many now feel they will beat the disease.

Valerie said: "I work in the operating theatres at the hospital and meet a lot of cancer patients coming into theatre who are generally more optimistic. They say things such as: 'I went to my GP as soon as I noticed and was referred really quickly' or 'I was only at the GP's last week and now I'm here having surgery. Hopefully, we've got it soon enough and I'll be OK'."

And Valerie says she reassures them with her story. "I say: 'Look at me. I'm four years down the line'. And they are amazed."

Updated: 09:41 Thursday, February 05, 2004