Aspirin and TP53 - Letter in British Medical Journal

There's been a flurry of papers recently on the effects of aspirin in cancer prevention. Some people have raised the possibility of prescribing aspirin to the general population, or at least everybody over a certain age. However, while the argument will go on for a while, there's some parts of the population in urgent need of cancer prevention strategies. In particular, people with a defective TP53 gene or Li Fraumeni Syndrome are at incredibly high risk of developing the disease and yet no research is being carried out on active measures to stop the disease occurring.

Aspirin might or might not make a massive difference, but even if it only makes a small difference that's still positive. What we need is the research to start now. And this is the point I make in a letter published today in the British Medical Journal. The letter can be accessed online here: http://www.bmj.com/content/344/bmj.e2480/rr/586138

This is an idea that needs to be pushed actively, and I hope to follow up with a more formal paper or article. The more we can do to kick start the research the better.

The Wrong Models of Cancer - Part 2

In the first part of this article I discussed one aspect of how researchers have modelled cancer in the test tube and how this has been a factor in the slow progress in 'the war on cancer'. To recap quickly, by ignoring the evolutionary processes taking place in cancer cell lines, in petri dishes and in implanted tumours, researchers are often surprised that what works in a lab doesn’t translate to the clinic. They’ve been targeting a different type of cancer cell to the ones that affect people. A tumour is more than a blob of a single type of deranged cell. It’s an entire eco-system of  'cancer' cells, the surrounding tissue (the stroma), disordered blood vessels, immune cells and so on.

But this is not the only type of wrong model. There is another that has had equally disastrous results – and it begins with the very phrase 'the war on cancer'. This metaphor of cancer as a war reflects the belief that the only way to deal with cancer is to eradicate it completely. Cancer cells have to be destroyed once and for all, and therefore the most radical and demanding treatments are used. Our current range of cancer treatments are some of the most demanding and dangerous in medical practice. Radical surgery, toxic chemotherapy, burning with radiation… These treatments are barbaric but it’s the best we have so long as the intention is to go in and kill every single cancer cell that exists.

BBC Catches Up With Anticancer.org.uk

I know that's a bit of a cheeky title, but I do feel the need to point out that today's story on the BBC website: 

Curry's ability to fight cancer put to the test

is about the curcumin and chemotherapy trial that I wrote about here on the 19th December 2011:

http://www.anticancer.org.uk/2011/12/curcumin-trial-in-uk.html

In any case, it's a story worth keeping an eye. Of the many naturally derived substances that show anti-cancer ability, curcumin is one of the most promising, but also one of the most problematic. As a single agent it clearly doesn't have a strong enough anti-cancer action, even at high doses, so combining with other agents, like standard chemotherapy drugs, is a good strategy.

Ultimately though, I strongly suspect that it will be engineered molecules that are derived from curcumin that will make it into the clinic first. There are already different curcumin analogs showing promise in animal models - though none have made it to patient trials so far.

Osteosarcoma outcomes getting worse

As regular readers will know, my son George died from metastatic osteosarcoma just over a year ago. What struck us at the time was the fact that there were no new treatments on this horizon - and that the obvious things to try (like zoledronate, ibandronate or other bisphosphonates) weren't being trialled despite them being used in palliative care for bone metastases in other cancers.

I've also written about the awful bone cancer statistics in the UK before. Now a new study (A Meta-Analysis of Osteosarcoma Outcomes in the Modern Medical Era,  Sarcoma, 2012) looks across the board at how osteosarcoma survival statistics have changed over the last thirty years. The findings are pretty grim:

Our study confirms suspicions regarding the lack of statistical improvement in osteosarcoma survival over the last thirty years. In fact, DFS (disease free survival) at the 3-year, 5-year, and 10-year marks have shown recent decreases over the last two decades. After steep improvements up until the 1970’s, overall survival at the 5 and 10-year marks has simply plateaued with lack of statistical improvements. Similarly, recurrence rates have fluctuated in the modern era, without significant improvement. This lack of improvement is also true in subset populations like pelvic metastatic cases, with actual decreases in survival in both of these populations over the last two decades, though these decreases did not reach statistical significance.

In other words not only have things not improved, they've gone backwards.  

This stinks. If the treatments haven't changed, then what explains the decreased survival? The drugs haven't changed, so what has? It can only be the formalisation of protocols and clinical practices.

Surely this is an issue that deserves some priority - including from anticancer activists and campaigners.

George - One Year On

Loss. Such a small word to describe such a vast depth of sadness and heartache, but it's the word that best describes what we feel. It's so hard to believe that it is one year to the day that Georgie died. One year. We function now. We go to work, to school, engage with the world. But that sense of loss is with us always; an invisible cloak of sorrow that cannot be shed.

In that year we've made small steps to honour George's memory - such as setting up the TP53 Trust in his name - and have come to know other families with similar horrific histories. With time we hope we can make more progress, to make a real difference in the fight against this evil disease. It won't bring George back - the world will never regain its shape - but if we can help others to avoid the same loss, then perhaps it will make our loss easier to bear. George would have approved.

Is Mammography Screening Always A Good Idea?

I had, like most people, always assumed that mammography screening was a thoroughly good thing. If there was a controversy about, I had assumed it would be one that would come down to costs versus benefits. The assumption being that the only thing stopping mammography screening being rolled out to younger women was just about money. At no point had it ever occured to me that there might be scientific controversies associated with screening. That was until I found out about Peter Gotzsche and his argument that mammography screening was actively harming women. My first thought was that this must be about sloppy diagnosis - if women were being harmed it was because some of them are being misdiagnosed and then subjected to the array of harsh treatments - chemotherapy, radiotherapy and radical surgery. But no, his point is more subtle than that and comes down to basic oncology. His key finding, based on the data from randomised clinical trials, is that women are being over-diagnosed. And it wasn't until I read his book, Mammography Screening: Truth, Lies and Controversy (which I have reviewed here: http://www.londonbookreview.com/lbr0067.html), that I got the point.

In effect it boils down to a simple fact - not all breast cancers will grow, spread and ultimately kill the women who develop them. There are cancers that are slow-growing or which sprout, shrivel and die and which actually do not cause any health problems whatsoever. Many women will develop these types of tumours and never even know it. The problem is that we don't have any clear way of differentiating between these tumours and the ones that turn into killers. What screening does then is pick out all tumours - the safe and the dangerous. And because we don't know which is which doctors have no choice but to treat them all. It's not that women are being misdiagnosed, the tumours that are picked out are real, it's that some of those tumours are less dangerous than the treatments that follow.

Introduction to LFS - Leaflet

One of the things that sufferers of Li Fraumeni Syndrome have to deal with is the complete lack of knowledge of the condition amongst most people. This is especially irritating when it includes doctors, nurses, health visitors and so on, as well as teachers, health visitors and so on. It takes time and energy to keep having to explain what TP53 is and how it can cause LFS and so on. As one way of short cutting all of this the George Pantziarka TP53 Trust has just published an introductory leaflet that can be downloaded, printed off and passed around to those people who want to know more or who need to understand what it means for sufferers.

The PDF can be downloaded directly from the site here: http://www.tp53.co.uk/index.php/lfs-leaflet