Wednesday 21 February 2018

Terminal decline: how we're winning war against cancer

At last ... the dreaded disease that has cursed virtually every family is loosening its morbid grip. Kim Bielenberg reports on the great medical advances that have tipped the balance and Professor John Crown highlights the battles still to be fought

Ryan Healy Nolan is now four years in remission. Photo: Pat Moore
Ryan Healy Nolan is now four years in remission. Photo: Pat Moore
Dr Antoinette Perry is hopeful about new treatments
Kim Bielenberg

Kim Bielenberg

The scientist Gerard Evan believes his children will have more to fear from global warming than from cancer when they grow up.

The professor of biochemistry from Cambridge University created a stir at a conference in Dublin in recent days when he predicted that cancer as a terminal disease will be eliminated in our lifetime.

The diagnosis of cancer still causes great shock among Irish families, and is the country's second greatest killer after heart disease, with 9,000 deaths every year.

But most Irish patients now survive their illness for a long period, and with the most common cancers –affecting the prostate and breast – nine out of 10 patients will live for over five years, and many well beyond that.

We may now have reached a tipping point where the Big C will no longer have a morbid stigma attached to it in years to come.

Seventy years ago, TB was the scourge that killed thousands in Ireland, until medical research and programmes put in place by Health Minister Noel Browne and others helped to eradicate it. Is cancer about to go the same way?

Professor Gerard Evan predicts a time in 30 years when people will say: "At least it's only cancer."

"Cancer will be a containable and largely a treatable disease by then," the cancer researcher told Weekend Review.

"Whether we will be able to eradicate it completely is not clear, but with so many effective drugs available we will be able to keep knocking it back without the terrible side effects of the classical cancer therapies."

Already the chances of survival for Irish patients have improved dramatically in recent years.

Back in the late '90s, up to 69pc of those diagnosed with prostate cancer in Ireland did not live beyond five years, but the survival rate has grown to 93 pc.

Dr Antoinette Perry, Senior Research Fellow at Trinity College, has been studying new ways of treating prostate cancer, and can see a time in the future when survival rates will be close to 100pc.

"I believe in the future we may not eliminate it completely, but I believe we can alleviate suffering and dying as a result of it," says Dr Perry, the lead investigator in a research team looking at prostate cancer.

"We are studying the molecular biology of the tumours. By knowing what is causing the tumour at a molecular level, we can work out which tumours will respond to which drugs.

"In the future, cancer treatment will be moving much more towards personalised medicine."

Rather than a one-size fits all approach, consultants will be able to see which drugs respond to particular genetic changes in cells.

Dr Conleth Murphy, oncologist at the Bon Secours Hospital in Cork, says: "There have been considerable improvements in some treatments because of drugs."

Over a decade ago, patients in the advanced stages of the lethal skin cancer melanoma faced a death sentence, and they would commonly only live for six to nine months.

But the use of the new drug Ipilimumab, which harnesses the body's immune system, revolutionised treatment.

"Now with the treatment, some patients have survived for 10 years. It has been an extraordinary change in a short space of time," says Dr Murphy.

"There are some trials showing immune-based treatments are working for lung cancer and that could be a huge development."

If scientists can develop more effective treatments for lung cancer, it would be a major breakthrough.

Although survival rates have gradually increased to around 13.5pc, lung cancer remains our worst cancer killer, causing almost 2,000 deaths every year. The incidence is actually rising among women, and falling among men.

As well as the development of new drugs, two other factors have contributed to rising survival rates for cancer in Ireland.

Local politicians may have screamed blue murder, but the move of cancer treatment from dozens of small hospitals scattered across the country into eight "centres of excellence" has also played a significant part.

"Ten years ago if you went for treatment for prostate cancer, you might have been treated by a general surgeon in a local hospital, who might have done one or two of these in a year," says Donal Buggy, head of services at the Irish Cancer Society

"Now you would be treated by someone who has dealt with 200 in a year. There is much greater expertise. If the surgeon sees something unusual they know how to tackle it."

Consultants and researchers in Ireland also give credit to Professor John Crown, oncologist at St Vincent's Hospital, for setting up ICORG, an organisation that has pooled the cancer expertise in Ireland and made the country a centre for research.

"As a result of co-operation between oncologists, surgeons and researchers in Ireland, new cancer treatments have been available faster in Ireland," says Professor William Gallagher, a specialist in Cancer Biology at UCD.

Professor Gallagher said Ireland had been a centre for clinical trials for the breast cancer drug Herceptin. This has helped to save thousands of lives.

In the late 1990s, around 75pc of Irish women with breast cancer survived for over five years. With technological advances and improvements to Irish treatment, this has grown to 85pc.

Scientists are now increasingly confident that in coming decades these figures will be brought much closer to 100pc.

"The pace of scientific change has quickened recently," says Professor Gallagher. "We are now in the middle of a biological revolution that is as profound as the industrial revolution.

"Scientists are studying the genetic sequences of a person. With this knowledge they are able to work out which drugs work for each individual."

Meanwhile, Irish breast cancer detection rates are set to be improved by up to a whopping 50pc thanks to a hi-tech new 3D digital screening system.

The system, known as Digital Breast Tomosynthesis (DBT), is being launched at the Bons Secours Hospital in Cork and is expected to soon become commonplace in Ireland.

DBT is now in widespread use in the US, UK and the EU where it has been found to be effective in helping diagnose early-stage breast cancers. The 3D imaging system allows for a more effective diagnosis.

While new drugs are being developed, cancer treatments remain enormously expensive.

Professor William Gallagher says it commonly costs over €1bn to develop a new drug, and there are a lot of failures along the way. A course of treatment may cost up to €200,000 and drugs don't always work on all patients.

As more patients go on to survive their cancers, and possibly live for decades afterwards, they will still have to cope with some of the debilitating effects.

Survival rates for prostate cancer may be extremely high, for example, but patients may still suffer incontinence or erectile dysfunction.

Donal Buggy, head of services at the Irish Cancer Society, says: "In the future we will have to pay more attention to survivors, and in particular their psychological needs. We need to develop psycho-oncology services in Ireland.

"Sometimes the fear of cancer can be worse than the cancer itself.

"We need to put in place a whole support structure for cancer survivors so that they can live life to the full.

"There is progress that can be made in improving diet and encouraging people to take exercise in order to prevent the recurrence of the disease," says Mr Buggy.

"Alleviating stress plays a very important part in this."

For the patient, battling cancer and surviving is unlikely to be an easy process any time soon.

However, Professor Gerard Evan said that with new treatments the side effects will not be nearly as bad as they used to be.

"Some of the present therapies work because they are general toxins. They work because you hope they will kill the cancer before they kill the patient. That is not an ideal way to treat human beings.

"The treatment will be a lot more targeted to the specific things that have gone wrong with that person's cancer. They won't have the general side effects that cause hair loss, diarrhoea and vomiting."

Professor Evan believes we are on the cusp of a medical revolution. As he puts it: "This is the first time in the history of humanity that we have known we can find cures for cancer."

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