CANCER DEATHS DECLINING

The number of cancer deaths in the United States has dropped for the second year in a row, the American Cancer Society reported yesterday. The finding suggests that the small drop reported last year — the first in more than 70 years — was real, possibly the start of a continuing decrease and not merely a statistical fluke, researchers said.

The American Cancer Society's annual study of cancer mortality came out yesterday. And for the second year its great news.

The New York Times, though, has a tinge of pessimism in its second paragraph.
"Although the drop is notable, it still pales in comparison with the number of cancer deaths, 553,888 in 2004.....But it has taken enormous efforts and ingenuity to produce relatively small gains." And there is a graph attached to the piece which makes out that cancer mortality has rising from about 400,000 deaths in the US to about 550,000 since 1980.

Well. Although its right to be cautious, these figures should be cause for enormous cheer particularly because cancer mortality is not an isolated statistic. Since the 1980s, the rates of heart disease have declined by about 25 per cent since the mid 1980s. As the leading cause of death in the US is clattering down, people are dying of other things. And although cancer has been slow to catch up with cardiovascular treatments, it is catching up.

And more than anything this kind of statistic rebutts the widely held belief that cancer rates are increasing.

Link: Second Drop in Cancer Deaths Could Point to a Trend, Researchers Say - New York Times.

ONE IN FOUR PEOPLE SAY CANCER IS DOWN TO FATE

Cancer Research UK did this amazing piece of research, and they discovered that one in four people think that cancer has nothing to do with risk factors and is only down to fate.

It is amazing, after half a century of campaigning about smoking, and twenty five years about the sun, and a least a few decades about five fruit and veg a dag, how little the message gets through. In poorer areas, that number reaches almost half of the population believes its fate.

I think one of the reasons is the complete mumbo jumbo that is so often spoken about the disease. Yesterday a faith healer (admittedly quite a comic one) was on BBC2 explaining that cancer is all about emotions, and Sense About Science recently wrote about the rubbish that celebrities speak about science.

And this really affects people's lives.

It really is time to change how we think about cancer.

"Monkeys, Rats and Me" is now online

My documentary about animal rights and experimentation that was broadcast on the BBC in November has been placed online, not sure by whom.

I'm told by my sources close to the animal liberation movement that the film is also being recut and portions of it are being passed around with their own particular slant. In the event that I can't police that, I figure that having the full thing downloadable at least allows people to see it in its full context.

I really hope more people get to see it. Although the images are a little dodgy, I think the content is as vibrant as provoking as ever.

I'm not sure what the copyright status of it is, I imagine many of the rights are part of the blanket BBC deal. But until the BBC gets its act together to put all this kind of stuff up immediately after its broadcast it seems like its fair game for it to be online.

The links are as follows.
On Google Video. Here.
And in the Internet Archive. Here
I guess its not on Youtube because it doesn't break into 10 minute chunks.

Links to the very fine reviews are here.

The Reviews.

“ONE IN THREE shines like a good deed in a world full of unnecessary books…… Wishart has produced a book that is informative, balanced, accessible, and absolutely riveting.” David Lodge's Pick of 2006 in the Guardian, author of Changing Places, Small World.

"For clinicians, this book may be a useful source of information to recommend to patients, or it may serve simply as an interesting read into how contemporary cancer research and treatment came into being." LANCET ONCOLOGY

“Adam Wishart's extraordinary book will be indispensable to anyone dealing with cancer, because it is so clear-eyed, so measured, so informative, and so quietly moving. He elegantly integrates the history of cancer research with the story of his father's illness. In doing so, he makes abstract science accessible and dignifies a human story with the insights of medicine. After reading this book, you have not only more knowledge, but also more insight and compassion.”
Andrew Solomon, author of Noonday Demon, a New York Times bestseller

“Wishart succeeds brilliantly in constructing a narrative that is a tribute both to his father and the scientists who have partly unpacked the mystery of cancer” Simon Singh, Sunday Telegraph

“An imaginative fusion of anecdotal detail, medical science and poignant, elegiac narrative marks every chapter of this unusual book.....Wishart’s book inhabits a remarkable genre of its own.” John Cornwell, The Sunday Times

"Wishart seamlessly weaves together the personal, the historical and the scientific threads of his narrative to tell the story of cancer" The Guardian

“[An] immaculately researched tale of medicine's struggle with cancer..” Lindsay Banham, The Lancet.

“ONE IN THREE offers real hope.” British Medical Journal.

“From one family’s cancer fight comes a book to help us all.’ Brian McIver, Daily Record

“ONE IN THREE is a consuming read. Part history lesson, part sociological study, part scientific journey, Wishart artfully serves up the right mixture of technical terminology, explanation and personal story….. Moments are beautifully described … and it is a privilege to be given such access to the workings of the human heart.” Jacqueline Burton, Sunday Business Post.

“Calm, factual, beautifully written, intelligent and moving. ... this book brings understanding, and most of all it also brings some hope.” Literary Review

“A neat and moving blend of science and the intensely personal.” Mary Braid, Sunday Times in Scotland

“Perhaps the most readable and comprehensive account out there of our battle with the big C." Michael Bond, New Scientist

“An amazing book - it stands out as being an intelligent, balanced review of a complex and emotive subject. It's simply the best in its class today. Essential reading for anyone who has cancer or loves someone with the disease." Karol Sikora, Professor of Oncology, Imperial College London, advisor to WHO Cancer Program

"This emotionally charged account distinguishes itself not simply in the way it gracefully meshes together complex, competing theories about the disease, but in its generous use of a loved one as a case study." Kim Hjelmgaard, Scotland on Sunday

BREAST CANCER INCIDENCE DROP

The sharp drop in breast cancer rates in the United States reported last week is astonishingly good news. It is the first major reduction in the incidence of a malignancy that strikes more than 200,000 American women every year — and kills some 40,000 annually.

This is extraordinary news. For the first time incidence in breast cancer is declining massively, by 7 per cent. It seems likely that is linked to the declining use of hormone replacement therapy. Which all goes to show that if we can understand the causes, then we can begin to tackle this disease.

Link: A big drop in breast cancer.

Picks of the Year

ONE IN THREE has been pleasingly picked in some of the pre-christmas roundups.

In the Observer.

Some words of praise for Adam Wishart's One in Three. Subtitled 'A son's journey into the history and science of cancer', the book interweaves two very different narratives: the history of cancer research and the story of how Wishart's father contracted and finally succumbed to the condition. The former sections are models of scientific clarity, the latter are powerfully written - and profoundly moving.

Link.

In the Sunday Times:

Although it enters a crowded field, Wishart’s account of his father’s death from cancer is moving, medically informed and exceptionally well written. Multiplying cancer cells are likened to “useless hotel bellhops passing on every bit of foyer gossip as a genuine message”. The aim, to dispel the “blind terror” that the c-word still evokes, is generously fulfilled, while he never shrinks from describing the irreparable loss of a parent’s death.

Link: Blowing their own trumpets .

And by David Lodge in the Guardian:

Adam Wishart's One in Three (Profile) interweaves a moving, but unsentimental, account of his father's last illness and death from cancer with a history of the disease and its treatment from classical to modern times. Informative, balanced, accessible, and absolutely riveting.

Link: Take a leaf out of their books .

Please do not try this at home

If ever anyone needs any reminder that we've come a long way in cancer medicine since the 19th century, just look at this strange patent. Its intention was to stop breast lumps, in the hope that preventing them growing. It just looks bonkers.

LINK

Another Breast Cancer Gene

Today the Guardian announces that

"Cancer specialists will announce today that they have discovered a gene which may hold the key to a treatment for up to 10% of all breast cancers. The development could - in time - lead to treatments that would make chemotherapy unnecessary."

I have very mixed feelings about the spate of these kind of stories. On the one hand this is clearly a great triumph for science. At last we are beginning to understand all of the piece of the cancer puzzle. Are ability to do so will definitely make it easier to design specific therapies in the future. Just our ability to unravel the complexity of cancer amazes me.

And yet these stories often come with a promise of an imminent therapeutic intervention. In the last few years, there have been all manner of these stories. Yet in fact the drugs have been much slower in arriving than they promise. Its not surprising, both Herceptin and Gleevec too about a decade from the identification of the gene to the discovery of the drug. But there is another point in all of this, and that is that stories like this seem to characterise cancer as the problem of a single gene. Now that is not true. And the real problem for researchers will be trying to identify and treat the clusters of genes that go to causing a single cancer. Its going to be complicated stuff, much more complicated than these kind of news stories make out.

Link: Scientists find genetic key to some breast cancers.

The Battle for the Oxford Animal Lab

My film has now got a slot. Here it is.

Monkeys, Rats and Me: Animal Testing
BBC2, 9pm, 27 November, 80 minutes

This year, the building of the Oxford animal lab has triggered the most important conflict between scientists and the animal rights movement for a century.

It began on 30 November 2005, when building work restarted on Oxford University's controversial £18 million animal experimentation laboratory - after contractors had pulled out previously after a campaign of threats and intimidation.

For the past year, RTS award-winning documentary director Adam Wishart (the author of ONE IN THREE: a son's journey into the history and science of cancer) has had a ring-side seat at the heart of the conflict. It's a story about how scientists who had been too scared to talk found a voice thanks to the campaigning efforts of a 16-year- old. And about the animal rights activists, who have been prepared to do anything in the face of an ever more determined Government.

The documentary has unprecedented access to all sides. It hears from Professor Tipu Aziz, a brain surgeon and experimenter on monkeys - one of the few Oxford scientists prepared to speak out. The programme follows an operation - which was partly developed using monkeys - by Prof Aziz on 13-year-old disabled boy. Will he walk again?

Cameras also follow animal rights activist Mel Broughton as he does his utmost to prevent construction continuing. And Laurie Pycroft, the 16-year-old founder of the Pro-Test movement campaigning for animal experimentation.

Beyond the shouting there is a moral question. Oxford University has given unprecedented access to the animal houses to reveal what happens to monkeys in experiments, and to rats as electrodes are inserted into their brains. Over the course of the film, Adam Wishart attempts to determine if these experiments are effective? And even if they are, are they ethical?

Red Meat and Breast Cancer

More bad news for red meat eaters. Not only is it bad for cancers of the gut, but it also seems to increase breast cancer risk.

Women who eat red meat every day are almost twice as likely to develop certain types of breast cancer, a long-term study published today has found.

Scientists who monitored 90,000 women for more than a decade found that those who ate a high meat diet were much more prone to developing the hormonally reactive breast cancers, which account for more than half of all breast cancers.

The scientists suggest that synthetic hormones used in meat production could be behind the trend.

The message is getting clearer and clearer.

Link.
Original Article.

PSA test - PROSTATE SPECIFIC ANTIGEN

My Dad always had a low PSA score. It meant doctors never thought he had a life threatening illness. At last there seems to be some hope that the PSA test is being refined.

The hoopla about the PSA test has been going on for more than a decade. At first it seemed almost like a panacea - men would be tested, cancer identified and eradicated - all would be good. But in the years since its introduction the PSA test has revealed many more men who have some kind of precursor to cancer which was not about to inevitably lead to death or illness. With so many so called ‘false-positives’ there has been much debate about whether the risks of the test were greater than the benefits of it. As a relatively young man, I’m only 39, its clear that the risks for me are much worse than the benefits. Even though something like twenty per cent of my age group probably already had some kind of precursor to the cancer – though many of these precursors wouldn’t hurt my life.

At last, though, the debate is moving on.

This month’s Journal of the National Cancer Institute has an interesting article about PSA. Rather than just trying to work out an absolute level, it comes to the conclusion that watching the pattern of the PSA is what is perhaps more important.

"In summary, when compared with a single PSA level threshold, the rate at which PSA levels reach a threshold value (PSA velocity) may provide useful information for identifying men who need further evaluation and/or closer surveillance for the presence of life-threatening prostate cancer."

My Dad had a pile of PSA tests. They all came up with numbers less than the supposed threshold of 4.0 ng/mL -whatever that means. Because it was below the threshold nobody thought it was important. But in the end he died.

The final conclusion of this paper, gives some hope that patients like Dad would not be overlooked in the future.

"When PSA levels are below 4.0 ng/mL, even small rises in PSA levels should prompt the consideration of the presence of a biologically important prostate cancer."

There is more discussion in the same journal here or in the New York Times here.

TESTICULAR CANCER - email of the month

I just received this rather lovely email from a patient. I'm grateful for the feedback, and also that the book can be useful to those who are younger than my father, and whose precise cancer is not described within it.

I am a 27-year-old cancer patient currently approaching the end of my chemotherapy. I had my diagnosis with testicular cancer in late May of this year only to find the cancer had spread to the back of my stomach. The prognosis is good with an excellent chance of ‘cure’ and my long-term outlook is fantastic.

I am writing to you as, I have read your book One in Three and want to thank you for providing me with a text that dispelled the myths, distortions and falsehoods that surround this disease. You’ve written a thoroughly comprehensive book that it is easily accessible, cool and collected in its approach to this emotive subject. The book has given me a good understanding of the history and science of cancer, which has definitely helped towards my feelings of empowerment over my illness. I would like to applaud your message that we desperately need to talk about cancer, without it being a dirty word. The taboo only encourages the suspicion and ignorance that surround the disease. The eventual defeat of cancer cannot just be a scientific milestone, but one of social inclusion. I’ve experienced the gob-smacking insensitivity of individuals who feel obliged to off-load their self-opinionated wacky theories, as to why I have cancer and to cure. There are a lot of well-meaning souls out there; who are actually quite dangerous, One in Three has been a fabulous anchor, when confronted by madness. I fully support any public discourse about cancer that will elevate the patient from modern day leper to a first class citizen. The prejudice surrounding cancer is just, if not more of an obstacle to its defeat, as it is a medical conundrum.

A Lung Cancer Breakthrough? - annual CT scanning

My contention is that it is rare to see in the newspapers a proper cautious approach to the dilemmas of prevention. Truth is, that the balancing of risks and benefits doesn't make that great storytelling, its too equivocal, and its too cautious for great journalism. But these careful judgements are the truth. I talk about one such story in a latter chapter in my book.

But here is a rare example. The good old New York Times in an editorial about a new lung cancer study.

Some cancer experts and advocates for lung cancer patients are hailing the dawn of a new era in which lung cancer will move from a disease that is usually fatal to one that is usually curable. So why do many experts have misgivings about recommending widespread CT scan screening?

For once it seems that the newspaper is offering the proper analyis, whilst the New England Journal of Medicine is offering a much less rigorous view.

Conclusions Annual spiral CT screening can detect lung cancer that is curable.

BREAST CANCER SCREENING

Today there is much hoopla about a new report from the nordic cochrane collaboration. The Press Association tells us that "thousands of women in England could be undergoing unnecessary and potentially devastating treatment for suspected breast cancer".

The Today Programme says that "new research says that breast cancer screening might be doing more harm than good."

The Telegraph that "Screening for breast cancer 'may harm women'"

Because the Cochrane collaboration is one of the most authorative in the world its worth taking it seriously. And yet if you actually read the paper itself its not the big news that everybody is going on about. In fact, the evidence is very similar to much that has been around for at least a decade. There is a chapter in my book which outlines a political scandal around similar figures in 1997.

And even though its not new, the paper itself seems to be much more tentative than the headlines.

Screening likely reduces breast cancer mortality. Based on all trials, the reduction is 20%, but as the effect is lower in the highest quality trials, a more reasonable estimate is a 15% relative risk reduction. Based on the risk level of women in these trials, the absolute risk reduction was 0.05%. Screening also leads to overdiagnosis and overtreatment, with an estimated 30% increase, or an absolute risk increase of 0.5%. This means that for every 2000 women invited for screening throughout 10 years, one will have her life prolonged. In addition, 10 healthy women, who would not have been diagnosed if there had not been screening, will be diagnosed as breast cancer patients and will be treated unnecessarily. It is thus not clear whether screening does more good than harm. Women invited to screening should be fully informed of both benefits and harms.

Its interesting that none of the media outlets link to the paper itself despite it being on public access.

Amidst the panic that goes on around a story like this, the key message that women should be allowed to make a real informed decision always seems to get lost. Surely its down to the patients, not the bureaucrats to make choices like this.

TIMES LITERARY SUPPLEMENT REVIEW

'As well as admirably filling the gap that the Wisharts identified for an intelligent and humane account of cancer, this wise, dignified book will contribute to a rejection of unsatisfactory theories and practices and the adoption of something better."

LINK

Lancet Oncology Review.

"The scientific and clinical content of the book is accurate, engaging, and accessible to those with little scientific knowledge... sections of the book impressively convey issues that people sometimes grapple with"

It's strange how people tend to notice the smallest inconsequential things about a day that changed their lives forever—the falling rain, the colour of their shirt, the strength of their coffee. Such sensual experiences become embedded in memories, adding detail to an experience that is almost inhuman. One in three: a son's journey into the history and science of cancer effectively captures the real and seemingly surreal aspects of family life that occur after a diagnosis of cancer. Moreover, Wishart's book tacitly adds myriad details to the lives of those who have played a pivotal part in cancer research and treatment.

Marrying together the narrative of his father's diagnosis, treatment, and death from cancer of an unknown primary site with that of a history of cancer, Wishart begins with the surgical removal of a tumour in the vertebrae of his father's neck, and uses this as a vehicle to describe the first tumour excision in front of an audience of London doctors in 1831. Subsequent chapters follow a similar, rather arresting reading format: his father's continued treatment with radiotherapy, chemotherapy, and alternative medicine introduces readers to those who made a notable contribution to cancer. Wishart has penned excellent portrayals of the lives of Rudolf Virchow, Marie Curie, Wilhelm Hueper, Richard Doll, Austin Bradford Hill, Sidney Farber, Mary Lasker (who kick-started Richard Nixon's war on cancer), Penny Brohn (who established the Bristol Cancer Help Centre in the UK), Robert Weinberg, and Bernard Fisher. Throughout, the political context in which these people worked enriches the text. Of particular note are the descriptions of Marie Curie's work as she lobbied for research funds in the USA and that of Bernard Fisher's breast-cancer prevention trial, which is written with great insight into the point of view of society and the media during that time.

The scientific and clinical content of the book is accurate, engaging, and accessible to those with little scientific knowledge; however, Wishart uses analogy as his vehicle of explanation to ensure that concepts are not oversimplified. Some sections of the book impressively convey issues that people sometimes grapple with: a chapter on prevention, for instance, discusses the difficulty in communicating risk, and in developing and licensing a drug—in ensuring that its benefits justifiably outweigh the risks. For clinicians, this book may be a useful source of information to recommend to patients, or it may serve simply as an interesting read into how contemporary cancer research and treatment came into being.

Wishart's overarching theme is hope—that treatment and quality of life for patients with cancer worldwide will continue to improve, accompanied by improved understanding of cancer and greater empowerment of patients. One in three certainly contributes to these hopes.

Guardian Review

"Wishart seamlessly weaves together the personal, the historical and the scientific threads of his narrative to tell the story of cancer from the perspective of his father's illness. The result is both moving and informative, a book that tries to answer the questions Wishart's father asked when he was first diagnosed: what is cancer and why haven't we managed to cure it yet?"

LINK

Breast Cancer Patient Book Review

There is a lovely review from a message board:

"I'm someone who finds the shedloads of rubbish (to quote Kate Carr) on the shelves about cancer very depressing and undermining and isolating, but this book is exciting, powerful, real. A bonus too is that Wishart's father was, like me, an atheist and a humanist and so both father and son's attitude to death is eminently refreshing."

LINK for a bit more.

Radio Four / 4

Karol Sikora and I were on Radio 4's 'Material World'.

There is a link to it here. Its 14.25 minutes in.

Sunday Business Post

Moments are beautifully described in One in Three and it is a privilege to be given such access to the workings of the human heart. And yet, they are sparsely sprinkled over the course of this book......

One in Three is a consuming read. Part history lesson, part sociological study, part scientific journey, Wishart artfully serves up the right mixture of technical terminology, explanation and personal story.

LINK.