Wednesday January 14 2015
Cancer rates are dropping while cure rates rise
“Cancer deaths will be eliminated for all under 80 by 2050,” The Independent reports. This is the optimistic prediction contained in a paper written by specialists in pharmacy from University College London (UCL).
The paper is an opinion piece (PDF, 2.1Mb) that points out that deaths from the most common cancers have fallen by nearly a third in the last two decades. This is due to factors such as the decline in smoking, more effective early diagnosis, and better drug and surgical treatments. However, it argues that a further reduction in death rates requires more advances in areas such as screening, genetic testing, cancer awareness programmes and innovative treatments.
It claims that further advances in prevention are needed, including the use of aspirin to reduce the risk of colorectal cancer and more effective treatment for late-stage cancers, so that people with advanced diseases can continue to live fulfilling lives.
In particular, it says that "winning the cancer war" depends on reforming a healthcare culture that discourages the reporting of "minor" symptoms that can indicate a serious disease, since all cancers are most effectively treated at an early stage.
To play “devil’s advocate”, you could argue that while certain trends are improving, such as a reduction in smokers, others are worsening, such as the number of people who are now obese. And, as a recent study found that we discussed last year, the UK is now one of the leading countries when it comes to the number of obesity-related cancers, such as bowel cancer.
Our advice is not to be complacent. It is unlikely that a cure for cancer will be available in the near future. Therefore, core cancer prevention recommendations, such as avoiding smoking, taking regular exercise and eating a healthy diet, remained unchanged.
Where does the report come from?
The report has been researched and written by academics from the School of Pharmacy at UCL. It is unclear whether the report has been peer-reviewed. The study was funded by Boots UK.
There is a potential conflict of interest as several of the measures suggested for improving prevention, early detection and treatments revolve around community pharmacists. While community pharmacists, such as Boots, do provide an essential service, they are not charities.
What type of study is it?
The study is a narrative review. This is a type of study that usually gives a comprehensive overview of a topic, rather than addressing a specific question, such as how effective a treatment is for a particular condition.
It does not report on how the search for literature was carried out or how it was decided which studies were relevant to include. Because of this, it is not a systematic review, where all of the relevant evidence is included based on pre-specified criteria. This means there could be gaps in the evidence that is presented.
What are the figures?
The basic UK figures provided are:
- 325,000 new cases of cancer in 2013
- 150,000 deaths from cancer in 2013
The incidence of cancer increases with age. The yearly risk is:
- 1 in 5,000 in people aged 20 or less
- 1 in 100 for people in their 50s
- 1 in 30 for people over 65
In 2011, nearly half of new cases were in people aged 70 or over, and more than half of the deaths were in people over the age of 75.
As cancer is more common in old age, the ageing UK population means that the incidence of cancer is higher than at any time in history. However, despite the increased number of cases, the death rate is improving. For example, deaths from the "top four cancers" (breast, lung, bowel and prostate) have fallen by 30% in the last 20 years.
The authors highlight the following factors that have contributed to this improvement:
- reduced smoking
- more effective early diagnosis
- better cancer treatments
What changes are proposed to improve cancer prevention?
The authors suggest:
- improving access to weight management programmes, such as through local pharmacies
- continuing smoking cessation services
- better screening for "pre-cancers", such as bowel polyps
- testing for genetic vulnerabilities, such as being a BRCA gene carrier
- improving access to immunisations, such as HPV and Hep B vaccination
- reducing the risk of bowel cancer by encouraging people in their 50s to take low-dose aspirin
What measures do they say could improve cancer survival rates?
The report says that there is room to improve the number of cancers that are identified at an earlier stage when there is more chance of a cure. They quote an estimate that 5,000-10,000 lives could be saved if the UK had the same rate as “the best in the world”. A component of this would be improving awareness of early symptoms and encouraging people to see a healthcare professional, including a community pharmacist.
They support continued research into more effective methods for diagnosis and better treatments. They also suggest improvements in supportive care provided for people with more advanced and metastatic cancers (cancers that have spread) or survivors who have long-term side effects as a result of the cancer treatments.
Most of the recommendations in this paper are already part of cancer prevention strategy and best practice guidelines.
The advice that all people over 50 should take aspirin is controversial. While there is some evidence of a protective effect, as we discussed last year, this has to be balanced against side effects such as peptic ulcers and bleeding from the stomach, particularly in older people. It's important to see your GP before deciding to take aspirin regularly.
This review could be considered to be over-optimistic. Recommendations regarding cancer prevention remain unchanged.
Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.