An effective cure for all types of cancer could be just five to 10 years away, according to Professor Karol Sikora, former head of the WHO’s cancer programme, reported in The Independent, ahead of World Cancer Day.
Survival rates have dramatically increased over the last five decades from an average of 24% the early 1970s to about 50%. But some forms of the disease have remained extremely hard to treat – just one per cent of pancreatic cancer patients and five per cent of those with lung cancer are still alive 10 years after diagnosis.
The Independent reports that speaking ahead of World Cancer Day, Professor Karol Sikora, former head of the WHO’s cancer programme, said advances in genetics meant doctors would soon be able to prescribe drugs specifically targeted at each individual’s cancer.
He said the tumours in 100 women with breast cancer would all be unique to each individual but “understanding the molecular cogs that make cancer cells different to normal cells and therefore developing drugs personalised to the cancer” would allow “personalised, precision medicine”.
“What it would do is suppress the cancer and convert cancer into a long-term chronic disease,” Sikora said. “Most patients with cancer tend to be in their 50s or 60s. If they live another 20 or 30 years, they would effectively live a normal lifespan.”
Sikora suggested this medical revolution would happened “in the next five to 10 years”. “There will be, not a cure-all, but a much better predictive way of knowing which drugs to give to which patients,” he said. “In the 1970s, the survival rate for testicular cancer went up to 98 per cent, so essentially it’s a cure. “I think there will be a sudden surge once we understand the data about the genome.”
The report says according to Cancer Research UK figures, testicular cancer has the highest 10-year survival rate, following by malignant melanoma (89%) and prostate cancer (84%). Some 78% of breast cancer patients live at least 10 years, along with 80% of Hodgkin’s lymphoma patients and 77% of those with cancer of the uterus.
The lowest 10-year survival rates are for pancreatic (1%), lung (5%) and oesophageal (12%) cancer.
The report says while there has been some progress on hard to treat cancers, others have remained stubbornly lethal. For example, the 10-year survival rate for brain cancer has gone up from 6% in the early 1970s to 14%, while the same figures for oesophageal cancer rose from 4% to 12%. However for lung cancer, the survival rate rose from 3% to 5% and has not changed for pancreatic cancer, although recent research was hailed as a significant breakthrough.
Dr Emma Smith, Cancer Research UK’s science information manager, said the charity was funding “cutting-edge research to find new ways to prevent cancer, to diagnose it early when treatments are more likely to work, and to develop more effective, kinder treatments”. “The good news is that for some cancer types, such as leukaemia and testicular cancer, many patients are cured,” she is quoted in the report as saying.
New guidance from the World Health Organisation (WHO), launched ahead of World Cancer Day (4 February), aims to improve the chances of survival for people living with cancer by ensuring that health services can focus on diagnosing and treating the disease earlier.
New WHO figures indicate that each year 8.8m people die from cancer, mostly in low- and middle-income countries. One problem is that many cancer cases are diagnosed too late. Even in countries with optimal health systems and services, many cancer cases are diagnosed at an advanced stage, when they are harder to treat successfully.
"Diagnosing cancer in late stages, and the inability to provide treatment, condemns many people to unnecessary suffering and early death," says Dr Etienne Krug, director of WHO’s department for the management of noncommunicable diseases, disability, violence and injury prevention.
"By taking the steps to implement WHO’s new guidance, healthcare planners can improve early diagnosis of cancer and ensure prompt treatment, especially for breast, cervical, and colorectal cancers. This will result in more people surviving cancer. It will also be less expensive to treat and cure cancer patients."
All countries can take steps to improve early diagnosis of cancer, according to WHO’s new Guide to cancer early diagnosis.
The three steps to early diagnosis are:
Improve public awareness of different cancer symptoms and encourage people to seek care when these arise.
Invest in strengthening and equipping health services and training health workers so they can conduct accurate and timely diagnostics.
Ensure people living with cancer can access safe and effective treatment, including pain relief, without incurring prohibitive personal or financial hardship.
Challenges are clearly greater in low- and middle-income countries, which have lower abilities to provide access to effective diagnostic services, including imaging, laboratory tests, and pathology – all key to helping detect cancers and plan treatment. Countries also currently have different capacities to refer cancer patients to the appropriate level of care.
WHO encourages these countries to prioritize basic, high-impact and low-cost cancer diagnosis and treatment services. The organisation also recommends reducing the need for people to pay for care out of their own pockets, which prevents many from seeking help in the first place.
Detecting cancer early also greatly reduces cancer’s financial impact: not only is the cost of treatment much less in cancer’s early stages, but people can also continue to work and support their families if they can access effective treatment in time. In 2010, the total annual economic cost of cancer through healthcare expenditure and loss of productivity was estimated at $1.16trn.
Strategies to improve early diagnosis can be readily built into health systems at a low cost. In turn, effective early diagnosis can help detect cancer in patients at an earlier stage, enabling treatment that is generally more effective, less complex, and less expensive. For example, studies in high-income countries have shown that treatment for cancer patients who have been diagnosed early are 2 to 4 times less expensive compared to treating people diagnosed with cancer at more advanced stages.
Dr Oleg Chestnov, WHO assistant director-general for noncommunicable diseases and mental health, notes: "Accelerated government action to strengthen cancer early diagnosis is key to meet global health and development goals, including the Sustainable Development Goals (SDGs)."
SDG 3 aims to ensure healthy lives and promote well-being for all at all ages. Countries agreed to a target of reducing premature deaths from cancers and other non-communicable diseases (NCDs) by one third by 2030. They also agreed to achieve universal health coverage, including financial risk protection, access to quality essential health-care services, and access to safe, effective, quality and affordable essential medicines and vaccines for all. At the same time, efforts to meet other SDG targets, such as improving environmental health and reducing social inequalities can also help reduce the cancer burden.
Cancer is now responsible for almost 1 in 6 deaths globally. More than 14m people develop cancer every year, and this figure is projected to rise to over 21m by 2030. Progress on strengthening early cancer diagnosis and providing basic treatment for all can help countries meet national targets tied to the SDGs.
“One in three cancer cases can be prevented ‘through simple changes to lifestyle and diet”, according to Dr Greg Hart, oncologist at Cancercare’s Rondebosch Oncology Centre. “World Cancer Day (on 4 February) is about spreading this message as far and wide as possible, encouraging people to look at the food they eat and the amount of exercise they do,” he said in a Health-e News report.
In 2011, the year for which the latest statistics are available, 60,000 South Africans were diagnosed with cancer. For women, breast, cervical and colorectal cancer were the most common cancers. Prostate, lung and colorectal cancers were the most common for South African men.
“Cancer has a significant impact on the South African population and on the region,” said Professor Vikash Sewram, director of the African Cancer Institute at Stellenbosch University. “Therefore, cancer risk identification and prevention and advancements in the early detection and treatment are emerging national health issues that need to be dealt with appropriately in order to improve the quality of life and increase the life expectancy of South Africans.”
The report notes that according to the WHO, obesity in adulthood increases the risk of some cancer types including cancer of the oesophagus, colorectum, breast in post-menopausal women, endometrium and kidneys. Eating a healthy diet and increasing physical activity “is an important approach to cancer control” and “needs to start in childhood”, said the WHO.
Exercise can not only help prevent cancer but it can aid those already diagnosed with the disease. Research from Macmillan Cancer Support has found that exercise drops the risk of recurrence and death in breast cancer patients by up to 40%. It can also help cancer patients manage fatigue, depression and heart damage “that go alongside treatment”. “Regular exercise doesn’t mean a daily marathon or spending hours at the gym,” said Hart. “For those who lead sedentary lives now, it is as simple as getting up and taking a walk every other day. Start out slow and short, and build up to longer sessions as often as possible. Fit it in around work and life, and choose an activity you enjoy.”
He said: “If we can encourage people to give up sedentary lifestyles, then we are already making a difference in the battle against cancer.”
[link url="http://www.who.int/mediacentre/news/releases/2017/early-cancer-costs/en/"]World Health Organisation material[/link]
[link url="http://www.who.int/cancer/publications/cancer_early_diagnosis/en/"]WHO guide[/link]
[link url="https://www.health-e.org.za/2017/02/04/prevent-cancer-exercise-good-food/"]Health-e News report[/link]
[link url="http://www.independent.co.uk/life-style/health-and-families/health-news/world-cancer-day-2017-effective-cure-will-happen-five-to-10-years-expert-karol-sikora-a7558846.html"]The Independent report[/link]
[link url="http://www.cancerresearchuk.org/health-professional/cancer-statistics/survival/common-cancers-compared#heading-Zero"]Cancer Research UK statistics[/link]