By Oliver Shannon & Ruth Norris
World Cancer Day, which occurs every year on 4th February, is an international initiative intended to raise awareness of cancer and take action to improve the prevention, detection, and treatment of this condition. In this article, we provide a brief outline of cancer and then include three separate cancer-related blogs by Dr. Fiona Malcomson (Senior Research Associate), Ruth Norris (PhD Student & Research Associate) and Dr. Christina Dobson (Senior Research Associate) on some of the promising cancer-related research going on within the Newcastle University Population Health Sciences Institute.
Cancer – a term which refers to a collection of diseases affecting every part of the body – is one of the leading causes of death worldwide, accounting for around 1 in every 6 deaths. Common types of cancer include breast, lung, colon, rectal, prostate, and liver. This condition occurs due to a transformation of normal, healthy cells into tumour cells via a series of processes that progress from a pre-cancerous lesion to a malignant tumour. These changes occur because of an interaction between an individual’s genetics and external agents (or carcinogens) which can increase cancer risk.
It is estimated that up to half of all cancers could be prevented by avoiding cancer risk factors and maintaining a healthy lifestyle (more on this later in the blog from Dr. Fiona Malcomson). Some of the things that we can do to help reduce the risk of developing cancer are shown in the image below.
Figure 1: Methods to reduce cancer risk (Image created by Oliver Shannon, information from https://www.who.int/news-room/fact-sheets/detail/cancer)
Cancer doesn’t affect everyone in the same way, and we know that certain groups of society may be less likely to receive a prompt diagnosis for cancer or, after diagnosis, obtain the treatment that they need (more on this in the blog by Ruth Norris below). There is clear evidence for inequalities in cancer care between patients of different ages, sexes and ethnicities – and, as discussed in more detail by Dr. Christina Dobson below, by geographical location too. Raising awareness of these issues and exploring potential solutions is one important way in which we can try to ensure equality for all individuals whose lives have been impacted by cancer.
Blog 1: Dr. Fiona Malcomson, Senior Research Associate
Lifestyle factors including body fatness, diet and exercise affect one’s risk of getting cancer and may also be linked to chances of surviving after cancer diagnosis. Approximately 40% of cancers in the UK could be prevented if everyone adopted a healthy lifestyle. The World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) – two leading bodies focused on understanding, preventing, and treating cancer – published 10 lifestyle-based Cancer Prevention Recommendations including maintaining a
healthy body weight, being physically active, and eating little red and processed meats.
In the CALIPER UK Study, we are using a large UK dataset (UK Biobank) to explore whether greater adherence to these Cancer Prevention Recommendations is associated with a lower risk of developing cancer. Later down the line, we will also be investigating whether better adherence affects chances of survival in people who have been diagnosed with cancer.
The UK Biobank is an invaluable resource which has collected a wealth of data on over half a million participants, including socio-demographics (e.g., age, sex, ethnicity), lifestyle factors (e.g., diet, levels of physical activity), and collects data on health-related outcomes, including cancer diagnoses, during follow-up.
We will first assess associations between a standardised score (used to measure adherence to the Cancer Prevention Recommendations) and the risk of all cancers combined and for cancers for which there is strong evidence for links with lifestyle factors, such as breast and bowel cancers. Through some methods-based work, we will see whether we can improve assessment of adherence to these recommendations by creating different score versions, and explore whether this should be tailored for specific cancers. For example, a large amount of evidence exists for links between eating too little dietary fibre or eating too much red and processed meat and bowel cancer. So, perhaps a score which gives a greater weighting to intakes of these foods will work better to predict bowel cancer risk.
The findings from this study could help to guide lifestyle recommendations and public health policies for the UK population, and for cancer survivors, to reduce the risk of cancer and improve length, and quality, of life. We are also investigating sociodemographic differences in adherence to these Recommendations, as both cancer incidence and survival are socio-economically patterned. Our findings may provide on which specific recommendations for cancer prevention could be tailored, or targeted towards, those in different socioeconomic groups in the UK.
Blog 2: Ruth Norris, PhD Student & Research Assistant
Equality – it’s not the first word that comes to mind when thinking about (or facing) a cancer diagnosis. Yet fair treatment and opportunity for all in cancer care is unfortunately not guaranteed. Rather, for many patients, barriers such as age, gender, income, ethnicity, education, and where you live negatively impact experiences across the care pathway from diagnosis to treatment and through to end-of-life care. This so called “cancer care gap” is ingrained and affects everyone – not just those in the most disadvantaged groups. Fortunately, the Union for International Cancer Control’s 2022-2024 World Cancer Day campaign (Close the Care Gap) aims to raise awareness and advocate for change, and as someone with an interest in cancer inequities – this move is very much welcomed.
My research has focused on determining whether socio-economic status (SES) acts as a barrier to novel cancer treatment. We already know that a low SES is associated with reduced access to conventional cancer treatments (surgery, chemotherapy, and radiotherapy). However, the way we treat cancer is also changing – we now have increasing use of novel, targeted treatments tailored to individual tumour genetics and immunotherapies which use the immune system to attack the cancer. What we don’t know is whether access to these newer cancer treatments is fair.
Our initial work, reviewing studies addressing this question suggested that a low SES was associated with reduced access to novel treatments. Similar outcomes were found when we analysed real world cancer registry data from England linked with a new drug database – the Systemic Anti-Cancer Therapy (SACT) dataset:
- Low SES reduces likelihood of new anti-cancer therapy receipt – even in a publicly funded healthcare system (English NHS).
- Low SES is a barrier to new treatment access across a range of cancers.
- In non-small cell lung cancer, patients living in the most deprived areas were 46% less likely to receive a novel therapy than those patients in the least deprived areas (Figure 2).
Figure 2: Likelihood (odds ratio) of novel anti-cancer therapy receipt by deprivation in non-small cell lung cancers diagnosed in England between 2012-2017. Multivariable model adjusted for: sex, age, diagnosis year, ethnicity, rural/urban indicator, stage, comorbidities & histology.
Moving forward, we still have some way to go to make cancer treatments equitable and to remove socio-economic barriers. First steps start with understanding why these barriers persist, followed by action to address imbalances. As one in two people will face a cancer diagnosis in their lifetimes, World Cancer Day 2023 serves as a reminder to all of us that “our time to act is now” if efforts to #CloseTheCareGap are to be successful.
For more information and to get involved, follow the campaign.
Blog 3: Dr. Christina Dobson, Senior Research Associate
World Cancer Day is a great opportunity to take stock and reflect on the diverse range of cancer research going on within the institute, and the shared- vision of reducing cancer inequalities and improving outcomes for patients. For instance, the COLO-SPEED research programme is galvanising patients, clinicians and academics to deliver world-leading endoscopy research into how we can prevent, diagnose and treat bowel cancer regionally (where we experience high health inequalities and deprivation), and nationally.
My work also focuses on inequalities and place, in relation to the experiences of rural patients. Rural cancer inequalities have been evidenced now for decades, but little research has been undertaken to understand the causes of this. Our recently published study identified barriers that rural patients face when it comes to seeking help for symptoms of possible bowel cancer. This work, funded by Yorkshire Cancer Research, showed that rural populations face specific barriers to early diagnosis, including:
– The financial and logistical constraints that people who are self-employed, particularly in seasonal industries (such as farming and tourism), face which can prevent them from seeking help about their symptoms.
– How rural living requires individuals to be self-sufficient, and stoic, qualities which can be detrimental when it comes to consulting GPs about symptoms early.
– And the importance of continuity of care, and a good relationship between GPs and patients, to encourage and empower patients to feel like they can consult.
Examining barriers to early diagnosis and survival for different patient groups, across the diagnostic pathway, is vital. Understanding the obstacles and challenges that different groups face enables us to go on to develop and tailor meaningful interventions that are acceptable to communities and can have a tangible impact on their diagnostic experiences, quality of life, and life expectancy.
Where can I learn more about cancer?
World Cancer Research Fund International:
An excellent resource for those interested in learning more about reducing cancer risk.
World Health Organisation:
The World Health Organisation Cancer fact sheet provides some great background information about the prevalence of cancer, its causes and treatments.
Cancer Research UK:
Check out the Cancer Research UK Cancer Research UK website for the latest developments in cancer research.