Diagnostics; making a difference

Diagnostics Blog


Cancer death rates to fall by 17 per cent in the UK by 2030

Sep 28 2012

As you will have no doubt seen over the past week, Cancer Research UK predicts that the rates of people dying from cancer will fall by 17 per cent (16.8) in the UK by 2030 according to new statistics new statistics released today by Cancer Research UK.

For all cancers, adjusting for age, 170 people in every 100,000 died from the disease in 2010 but by 2030 they have predicted this will fall to 142 in every 100,000. This is largely due to better survival rates, thanks to earlier diagnosis and improved treatments, but also reflects a reduction in smoking-related cancers leading to fewer deaths.

The new figures are released in the run-up to Stand Up To Cancer - an unprecedented partnership between Cancer Research UK and Channel 4 - which will culminate in a television fundraising entertainment extravaganza live on TV on Friday October 19th.

Ovarian cancer will see the biggest fall in people dying, with death rates expected to reduce by over 40 per cent (42.6) – dropping from 9.1 women per 100,000 to 5.3 by 2030.

The figures also show that breast cancer in women, bowel and prostate cancer will have huge reductions in the number of people in every 100,000 dying – falling by 28 per cent for female breast cancer, 23 per cent for bowel cancer and 16 per cent for prostate cancer.

But there are some cancers where the death rates are set to increase – 22 per cent for oral cancer from 2.9 to 3.5 per 100,000 people and 39 per cent for liver cancer, from 4.2 to 5.9 per 100,000.

Professor Peter Sasieni, Cancer Research UK epidemiologist at Queen Mary, University of London, said: “Our latest estimations show that for many cancers, adjusting for age, death rates are set to fall dramatically in the coming decades. And what’s really encouraging is that the biggest cancer killers – lung, breast, bowel, and prostate – are part of this falling trend.

“Because old age is the biggest risk factor for cancer and more people are living longer, they have a greater chance of developing and, unfortunately, dying from the disease. But, overall, the proportion - or rate - of those who die from cancer is falling.”

                                            Source: Cancer Research UK

As you can see, Cancer Research UK clearly view improvements in early diagnosis as vital in the battle against cancer mortality. At BIVDA we’re always trying to promote this message, but it is great to see CRUK emphasising the impact of early diagnosis too.

However, it is also important that the full range of IVD capability is understood by healthcare professionals, researchers and the public alike. IVD do not only diagnose. They are increasingly used to screen for disease, monitor treatment and even discover which treatment will be most effective for a patient. Marrying a diagnostic result to therapy selection can have incredible results for patients and organisation such as Cancer Research UK are leading the way on 'personalised medicine' development.

This week, Cancer Research UK have said that if you contract ovarian, breast, bowel or prostate cancer in 2030, your chances of surviving look notably better than they do today in 2012. So with the wide utility of IVDs in cancer treatment in mind, scroll down to see how these technologies are helping to fight the battle against cancer. We have given an outline of how IVDs are used to treat ovarian, breast, bowel and prostate cancers. 

Ovarian cancer:

Cancer of the ovaries is the fifth most common cancer in women. About 6,500 new cases are diagnosed in the UK each year. It is a more frequent cause of death than the more common, but more easily detected, cancers of the uterus and cervix.

Testing of symptomatic women includes:

• Cancer antigen 125 (CA 125)  measures a protein in the blood which is high in about 80% of those ovarian cancers which are derived from the surface cells. It may be used in with pelvic examination and a transvaginal and/or pelvic ultrasound to help diagnose ovarian cancer. CA 125 however, it is not specific enough to be used as a general screening test: increases in CA 125 levels are seen in other cancers, in hepatitis, pelvic inflammatory disease, and endometriosis as well as in early pregnancy and menstruation. It is mainly used as a tumour marker to monitor ovarian cancer treatment and to help detect early recurrence of cancer.

• Human Epididymis protein 4 (HE4). The combination of CA 125 and HE 4 has been shown to improve the chances of accurately detecting malignant ovarian cancer. It is promising as a marker for early detection by differentiating women with ovarian cancer from women with benign ovarian conditions. Studies show the benefit of CA125 and HE4 and their combined use as a diagnostic test for discrimination between benign and malignant ovarian tumours (Gynecologic Oncology 117, 440 – 445, 2010).

• AFP (Alpha fetoprotein) and hCG (human chorionic gonadotrophin) levels are increased in some ovarian cancers derived from the germ cells, but they are also elevated during pregnancy. If AFP or hCG are increased in a case of ovarian cancer, the tests can be used to monitor treatment and to detect recurrence of cancer.

• BRCA-1 and BRCA-2 are tests for two genetic mutations which have been associated with an increased risk of ovarian and breast cancer. These tests are usually done to screen and/or help diagnose a patient who has a strong family history of breast or ovarian cancer.

Breast Cancer

Each year, more women in the United Kingdom are diagnosed with breast cancer than with any other, cancer. 1 in 9 women in the UK will develop the disease at some time in their life. Breast cancer can develop at any age, but the risk of developing it increases as women get older. The majority of women who develop breast cancer are past the menopause but about 1 in 5 develop the condition below the age of 50. It is the commonest single cause of death among women in the UK between the ages of 35-45 years. While 5% to 10% of breast cancers are related to an inherited defect in one of two genes (BRCA-1 or BRCA-2), the majority of cases develop for reasons we do not yet understand. 

There are a variety of laboratory tests that can be performed to diagnose and monitor breast cancer and its treatment. These tests can be broken down into four groups, based on the purpose of testing:

To diagnose:

• cytology (the microscopic assessment of individual cells or groups of cells) and surgical pathology (removal of a small amount of tissue and/or fluid from the body which is examined by microscopic and/or other analytical methods to establish presence of cancer). 

 To monitor:

• CA 15-3 may be requested during follow-up following surgical removal of a breast cancer. It may be also requested when a patient with advanced breast cancer is receiving treatment. Changes in the concentration of CA 15-3 may indicate if a tumour is responding to treatment.

To determine genetic risk:

• The two genes BRCA1 and BRCA2 – which are located in different parts of the genetic code are examined in detail to look for differences from the usual ‘sequence’ of chemicals along the code. A difference that alters the message this genetic code sends to the body is often known as a ‘mutation’. Different mutations in these genes in different families have been associated with the development of breast or ovarian cancer. Individuals with a strong family history of breast cancer or ovarian cancer may want to know if they have an inherited tendency to these cancers. Sometimes a very young onset of breast cancer may also indicate a likely BRCA1/2 gene mutation.

To determine treatment options:

• Her-2/neu is an oncogene that is over-expressed in approximately 20% to 30% of invasive breast cancers. It is a protein that is present in very large numbers on the surface of some malignant breast cancer cells, causing these cells to rapidly proliferate. It is important because these tumours are susceptible to treatment with the chemotherapeutic agent Herceptin (Trastuzumab), which blocks the protein receptors, inhibiting continued replication and growth of the tumour cells. There are two common techniques used to determine Her-2/neu status in breast cancer: immunohistochemistry (a method for detecting the oncoprotein) and fluorescen in situ hybridization (FISH), a powerful technique for detecting gene amplification. Currently, the gold standard for assessing Her-2/neu status is immunohistochemistry, and the results are scored as 0, 1+, 2+ and 3+ where 0 and 1+ are considered negative results and 2+ (if confirmed by FISH) and 3+ are considered positive. A positive result makes the patient eligible for Herceptin therapy. Currently, FISH is used to confirm Her-2/neu positive status and eligibility for Herceptin in cases of 2+ immunohistochemistry.

• Oestrogen and progesterone receptor status is determined by immunohistochemistry. These are very important prognostic markers in breast cancer, and the higher the percentage of overall cells positive as well as the greater the intensity, the better the prognosis. In tumours that have these receptors, normal female hormones cause the cells to grow. The presence of cells in the tumour being positive for oestrogen and/or progesterone receptors is an indication for treatment.

Bowel Cancer

Bowel cancer is also known as colon, rectal or colorectal cancer. Bowel cancer is the third most common cancer in the UK, after lung and breast cancer. It is the second most common cause of cancer death, after lung cancer. Approximately 95% of all diagnoses are in people over the age of 50. Most cases of bowel cancer begin with the development of benign polyps, finger-like growths that protrude into the intestinal cavity. These benign polyps are not cancer and relatively common in people over age 50. They can become cancerous, though, with the ability to invade the normal bowel and spread to other parts of the body (metastasize). The tumours can create blockages in the intestine, preventing elimination.

The NHS Bowel Cancer Screening Programme now offers screening every two years to all men and women aged 60 to 69 in England using a guaiac based faecal occult blood test (gFOBT). The age range is currently being extended to 60 to 74. People within the age range are automatically sent an invitation, then their screening kit, so they can perform the test at home. After the first screening test, individuals are sent an invitation and screening kit every two years. The gFOBT does not diagnose bowel cancer, but the results will indicate whether an individual may need an examination of their bowel by colonoscopy.

For further information about the NHS Bowel Cancer Screening Programme see www.cancerscreening.nhs.uk/bowel/index.html. Separate screening programmes are offered in Wales, Scotland and Ireland.

There are four common screening tests for detecting bowel cancer:

• Faecal occult blood (FOB) test is a test for hidden blood in the stool.
• Sigmoidoscopy is an examination of the rectum and lower colon with a rigid or flexible lighted instrument.
• Double barium contrast enema is a series of X-rays of the colon and rectum. The patient is given an enema with a white, chalky solution that outlines the colon and rectum on the X-rays.
• Colonoscopy is an examination of the rectum and entire colon with a lighted instrument. It may be the most useful, but it is also the most invasive.

Prostate cancer

Prostate cancer is a relatively common type of cancer affecting the small walnut-shaped prostate gland located near the base of the bladder and found only in men. The gland surrounds the upper part of the urethra, the tube that leads from the bladder to the penis. In more advanced stages of the disease the tumour may spread and eventually be carried (metastasise) to other areas of the body.
In the UK there are about 30,000 new cases of prostate cancer each year. It is rare in men under 45 and quite common in men over 80. However, in older men the cancer is often small, restricted to the prostate and without symptom.

The tests most commonly used tests to investigate men with symptoms suggestive of prostate cancer are rectal examination and the Prostate-Specific Antigen (PSA) blood test. For the PSA test, blood is taken and sent to a clinical laboratory. There the blood is examined for an increased level of the blood marker which is associated with prostate inflammation or cancer.

Whilst the PSA level is raised in up to eighty percent of prostate cancers, an abnormal result does not necessarily mean a diagnosis of cancer. In fact, two-thirds of men with a raised serum PSA level do not have prostate cancer, although other abnormalities requiring treatment may be the cause of a raised PSA results. Rectal examination and PSA measurement can also assist in the early detection of benign prostatic hypertrophy (BPH).

PSA test:

• It may help pick up a significant prostate cancer before you get any symptoms
• It could help to monitor men who have a higher risk of developing prostate cancer
• It may help pick up a more aggressive cancer at an early stage when treatment may prevent the cancer from becoming more advanced
• Repeat PSA tests can identify changes to your PSA level that may show that there is a problem with your prostate
• It may help to pick up a non-cancerous prostate problem such as BPH or prostatitis

 59  2362  16/04/2015