Health charities have called for urgent action to tackle delays in access to diagnostic tests in England.
The latest figures show that in April, nearly 17,000 patients had been waiting more than six weeks for scans and investigations – including for cancer.
NHS England says most patients are investigated promptly, despite a big rise in demand for tests.
The NHS constitution says no one should have to wait more than six weeks for a diagnostic test.
The number of such investigations has risen steeply in recent years in response to growing demand.
But the proportion of patients missing the deadline – including potentially some with cancer – has doubled in 12 months to more than 2%.
‘Top priority’
Macmillan Cancer Support said the NHS was “under strain” and there was a danger of cancer being “overlooked”.
“Start Quote
The vast majority of patients get their tests promptly”
End Quote NHS England spokeswoman
Ciaran Devane, Macmillan’s chief executive, said: “It is extremely worrying that the proportion of people who face delays in receiving vital tests which can diagnose cancer has doubled since this time last year, from 1.1% to 2.2%.
“Only two weeks ago we heard that more people are waiting longer to start treatment and now more people are waiting longer just to get diagnosed.”
He added: “Each individual hospital has a responsibility to meet these targets, or they risk putting a patient’s best chance of survival at risk.
“However, this government and the next also need to take responsibility. Macmillan Cancer Support is urging all political parties to make cancer a top priority at the upcoming general election.”
NHS England says there were more than 50,000 additional tests carried out in April compared with the same time last year, and that most patients wait less than three weeks.
A spokeswoman said: “Timeliness of diagnosis and treatment is what patients expect and is essential to providing high quality care. The vast majority of patients get their tests promptly.”
The project will look at the DNA of both patients and tumours
A new initiative to develop ‘personalised cancer treatment’ has today been launched. The experimental project has been designed to develop a screening program to test tumours for key genetic changes. It is hoped that in the future the results of such tests would influence treatment programmes, helping doctors choose the best drug for each person.
The new initiative, called the Stratified Medicine Programme, is being led by Cancer Research UK, the UK Technology Strategy Board and the pharmaceutical companies AstraZeneca and Pfizer. It is hoped that the work will lay the foundations for genetic testing of both patients and tumours to become standard practice, allowing the use of specialised drugs that target specific genes and mutations that can cause or influence the development of cancer.
In addition to laying the foundations for a genetic testing service, the information collected during the programme may be useful for research into new treatments; for example, by identifying new targets and by seeing how genetics affect people’s responses to various cancer drugs. Although people taking part in the early stages of this programme are unlikely to directly benefit, in time it is hoped that in the long-term patients will be provided with individually tailored treatments that ultimately prove more effective.
What is the project looking at?
The project will initially look at mutations in breast, bowel, lung, prostate as well as ovarian cancer and melanoma. These cancers were chosen due to how common they are and because of the range of drugs available and in development that might potentially be used to treat them.
The project aims to collect samples from 9,000 patients treated at seven Experimental Cancer Medicine Centres around England, Wales and Scotland. This small-scale project will develop the best way of running a genetic testing service, which could then potentially be rolled out over the whole NHS.
How might this help fight cancer?
Although the process is still at an early exploratory phase, in the long term it is hoped that the programme will allow patients to be treated according to the specific genetic faults in their tumour.
As new drugs targeting cancers with specific mutations become available, they could be prescribed based on the genetic faults in the tumour and a person’s genetics, and potentially produce improved results. It might also reduce ineffective treatment, where the cancer does not respond.
Understanding how certain genes control cancer and determining how the disease evades treatment is another aim of cancer research. The genetic information collected will also provide a unique source of information to help guide future projects and drug development.
Cancer Research UK is currently involved in a number of other genetics-based research projects that might shed light on topics such as what makes certain people genetically susceptible to cancer, what genes and mutations cause cancer to progress aggressively once it does develop and how genetics govern the way some people respond to treatment.
How will the project work?
The first-phase of the project involves seven clinical centres and three genetic technology centres. Blood and tumour samples will be collected from patients treated at Experimental Cancer Medicine Centres to gather sources of both normal DNA and tumour DNA. The DNA sequences will then be examined to see if certain mutations are present in the tumour. The results will be linked to patient records, and anonymously placed in a central database to guide future research.
During this phase of the programme, the results will not influence treatment. However, they may show that a patient is eligible to participate in a clinical trial of one of the new targeted therapies, although this is likely to affect only a small number of patients.
Does the NHS presently examine genetics in cancer patients?
As some existing drugs are designed to treat cancers with certain mutations, genetic testing for single mutations is carried out in the treatment of some cancers. For example, the drug trastuzumab (Herceptin) is designed to treat breast cancers with high levels of the Her2 protein on the surface, which can be identified through genetic testing.
However, genetic testing of tumours to test for multiple genetic defects is not yet available on the NHS. At the moment there is no centralised way of testing samples, and therefore it is often done on a few samples at a time rather than on a large scale.
The aim of this programme is to develop a nationwide service, reducing variations and making results more comparable across the country.
US former world heavyweight boxing champion Joe Frazier is in hospice care with liver cancer, his manager says.
He says Frazier - also known as Smokin' Joe - was diagnosed with cancer several weeks ago. "I would be a liar if I did not tell you it is very serious," Leslie Wolf told Reuters news agency. The 67-year-old held the world title between 1970 and 1973. He was the first man to beat Muhammad Ali in 1971. He lost the next two bouts with Ali.
Mr Wolf said that Frazier was diagnosed with liver cancer last month and was now in hospice care in Philadelphia. "Joe is a fighter. Joe doesn't give up," the manager said, adding that doctors and Frazier's team were "doing everything we can". Frazier won the heavyweight title in 1970 by defeating Jimmy Ellis in New York. He held it until 1973, when he was beaten by George Foreman. But the boxer is perhaps most widely-known for three great fights with Ali, including the epic Thriller in Manila in 1975
A "fatty apron" in the abdomen helps fuel the spread of ovarian cancer, research suggests.
In 80% of cases, it has spread to this apron, called the omentum, by the time it is diagnosed.
The Nature Medicine research found once ovarian cancer cells reach the omentum, they take it over.
UK experts said the study was important in aiding understanding of ovarian cancer, the fifth most common cancer in women in the UK.
The omentum lies in the upper abdomen near the stomach. It helps support the organs nearby, but it is not essential.
Often, cancer growth in the omentum exceeds the growth of the original ovarian tumour.
The University of Chicago team injected ovarian cancer cells into the abdomen of healthy mice. They reached the omentum within 20 minutes.
They found that protein signals emitted by the omentum attracted the tumour cells. Disturbing these signals reduced this attraction by at least 50%.
Once ovarian cancer cells reach the omentum, they were found to change so they could feed off the fat cells.
Feeding cancer spread
The researchers suggest that a protein known as fatty acid binding protein (FABP4), a fat carrier, could be key to the process and could be a target for treatment.
Tumour cells next to fat cells in the omentum were found to produce high levels of FABP4, while cancer cells far away from fat cells did not.
The cells that make up the omentum contain the biological equivalent of jet fuel. ”
Prof Ernst Lengyel,Lead author
When the action of FABP4 was blocked, the transfer of nutrients from fat cells to cancer cells was drastically reduced. It also reduced tumour growth and the ability of tumours to generate new blood vessels.
Lead author Ernst Lengyel, professor of obstetrics and gynaecology at the University of Chicago, said: "The cells that make up the omentum contain the biological equivalent of jet fuel.
"They feed the cancer cells, enabling them to multiply rapidly. Gaining a better understanding of this process could help us learn how to disrupt it."
The researchers suggest fat metabolism may also contribute to other cancers, such as breast, gastric and colon.
Dr Kat Arney, of Cancer Research UK, said: "These are important results because they suggest that fat cells in the stomach can fuel the spread of ovarian cancer, and point towards potential targets for the development of new treatments for the disease.
"But at the moment these are still early experiments using mice and cells grown in the lab, so there's still a lot of work to be done to turn this knowledge into a treatment that could help women with ovarian cancer."
The Department of Health said it was already responding to the challenge.
The research presents projections for 23 different types of cancer. The results are based on taking figures from cancer registries going back to 1975, and then projected forwards to 2030, taking into account expected changes in population.
The study suggests that the number of new cases could rise from about 298,000 in 2007 to 432,000 by 2030 - an increase of 45%. The increase in men is forecast to be 55%, and 35% in women.
Drawing on data from the Office for National Statistics, the authors assume a rise in the population from 61m in 2007 to nearly 71m by 2030.
The proportion of elderly people is projected to grow at a faster rate. The figure for over 65s stood at 16% in 2007. By 2030 it is expected to reach 22%.
The NHS faces a perfect storm over the next 20 years.”
Harpal KumarCancer Research UK chief executive,
The impact of ageing is starkly reflected in the projected increase in the figures for prostate cancer, which is especially common in older men.
Cases are projected to increase from about 36,000 in 2007 to more than 61,000 by 2030. The authors say even this is probably an under-estimate because in future more men are likely to be tested for the disease.
Although the overall number of cancer cases appears set to rise, the authors conclude that after adjusting for the growing and ageing population, cancer rates are likely to remain "broadly stable". But there are variations within this.
The rate of breast cancer is projected to fall by 7%. The authors attribute this to a recent reduction in the use of hormone replacement therapy, which is a risk factor for the disease.
However the rates of malignant melanoma and kidney cancer are forecast to rise sharply in men and women.
One of the authors, Prof Peter Sasieni acknowledged that the figures should be treated with caution, but said they provided a framework.
"Projections of cancer cases are important for planning health services so we can understand where the future burden is on the NHS and also where health awareness messages need to be raised."
Cancer Research UK chief executive Harpal Kumar added: "At a time when the finances of the health service are being squeezed, it is absolutely crucial that health commissioners plan now for a massive increase in demand for cancer services, to ensure we provide high quality care to all."
The charity's director of health information, Sara Hiom, said: "Smoking and drinking alcohol are two of the biggest things that increase the chance of developing oral, liver and kidney cancer - so by stopping smoking and cutting back on alcohol, we can lower our risk of these cancers as well as other diseases.
"Maintaining a healthy bodyweight is also important in cutting the risk of liver and kidney cancers."
A spokesman for England's Department of Health said the NHS was already responding to the challenge of an ageing population and increases in cancer cases.
"That is why we are investing more than £750m over the next four years to make sure people are diagnosed with cancer earlier and have better access to the latest treatments," he added.
IVF has been linked to an increased risk of ovarian tumours in later life, according to a preliminary study.
Women given fertility drugs to produce eggs had more than triple the risk of an ovarian tumour that may turn cancerous, say Dutch researchers.
But the absolute risks are very low, they add.
A cancer charity said numbers involved in the study, published in the journal Human Reproduction, were too small to draw firm conclusions.
The study tracked more than 25,000 women attending IVF clinics in The Netherlands in the 80s and 90s.
Follow-up investigations revealed more cases than expected of ovarian tumours in women who had gone through IVF, which involves stimulating the ovaries to make eggs.
The biggest increase was in a type of growth, known as a borderline ovarian tumour, which can sometimes turn into cancer. It is less aggressive than other types of ovarian tumour, but requires surgery.
“Start Quote
Women should be informed about this but the risk should not be overstated”
End QuoteProf Flora van LeeuwenNetherlands Cancer Institute, Amsterdam
It normally affects around one in 1,000 women in the general population, but was found in about 3.5 in 1,000 women who had gone through IVF, say the researchers.
A smaller increase in other types of ovarian tumour was also found. Overall, ovarian cancer rates were twice as high among women who had gone through fertility treatment, the experts said.
Prof Flora van Leeuwen, a co-author of the study, told the BBC: "The absolute risk of these tumours is very low. But there is an increased risk of a borderline malignant tumour that needs surgery.
"Women should be informed about this but the risk should not be overstated."
Another co-author, Prof Curt Burger added: "The main message is that women who have had IVF shouldn't be alarmed. The incidence of ovarian cancer was extremely low."
'Reassuring'
Further research is planned to confirm the finding in a larger number of patients, and to look at whether some women are more at risk.
At present, the numbers involved are small. There were 61 women with ovarian tumours in the IVF treatment group; 31 had borderline ovarian tumours and 30 had ovarian cancer.
Ovarian cancer is the 5th most common cancer in women in the UK
Most cases are in women who are past the menopause
Risk factors include a family history of cancer, being infertile or having fertility treatment, and smoking
The symptoms of ovarian cancer can be very vague, particularly when the disease is in its early stages.
Early symptoms can include pain in the lower abdomen or side, and/or a bloated, full feeling in the abdomen
Source: Cancer Research UK
Commenting on the study, Prof Hani Gabra, of the Ovarian Cancer Action Research Centre at Imperial College London, said:
"Reassuringly, and in keeping with lots of previous research in this area, this study shows that the risks of invasive ovarian cancer are small in populations of patients receiving ovarian stimulation for IVF.
"Although this study shows that ovarian stimulation may increase the risk of much less aggressive borderline ovarian tumours, it underlines the fact that ovarian stimulation for IVF is not a major risk factor for invasive ovarian cancer."
Dr Claire Knight, senior health information officer at Cancer Research UK, said: "This interesting study suggests a possible link between ovarian stimulation for IVF and borderline ovarian tumours, but it certainly doesn't show that IVF causes invasive ovarian cancer.
"There were only a relatively small number of cases in this study, and the researchers didn't find that risk increased with the number of cycles a woman had, making conclusions hard to reach.
The value of breast cancer screening has been a source of controversy
The evidence for breast cancer screening in the UK is being reviewed amid controversy about the measure's effectiveness.
The NHS says screening saves lives, but other researchers have argued that it may cause more harm than good. The national cancer director for England, Prof Mike Richards, announced in the British Medical Journal that he will lead a review. He said he was taking the "current controversy very seriously". When it comes to cancer treatment, earlier is better. Screening programmes for a range of cancers help doctors make a diagnosis sooner. But they also run the risk of false positives, diagnosing someone with cancer when they are healthy. Life saving Screening was introduced for breast cancer in 1988 in the UK and now offers tests to women, over the age of 50, every three years. In 2002, the World Health Organization's International Agency for Research on Cancer estimated that screening reduced deaths from breast cancer by about 35%. The NHS says 1,400 lives are saved through screening in England alone.
“Start Quote
The decision whether to be screened is a personal one, but that decision should be made with all of the potential harms and benefits fully explained”
End QuoteSara HiomCancer Research UK
However, the evidence has been questioned.
A review of clinical trials involving a total of 600,000 women concluded it was "not clear whether screening does more good than harm". It said that for every 2,000 women screened in a 10-year period: one life would be saved, 10 healthy women would have unnecessary treatment and at least 200 women would face psychological distress for many months because of false positive results. The authors of that research labelled the NHS Breast Screening Programme's advice "seriously misleading". Exchange Professor of complex obstetrics at King's College London, Susan Bewley, has turned down screening. In a letter to Prof Richards last month, she said: "The distress of overdiagnosis and decision making when finding lesions that might, or might not, be cancer that might, or might not, require mutilating surgery is increasingly being exposed." In response, Prof Richards said research suggested that up to two and a half lives were saved for every over-diagnosed case. He added that he would lead a review of the evidence to settle the ongoing controversy. "Should the independent review conclude that the balance of harms outweighs the benefits of breast screening, I will have no hesitation in referring the findings to the UK National Screening Committee and then ministers.
Mammograms can identify tumours before they would be picked up
"I am fully committed to the public being given information in a format... that enables them to make truly informed choices." Prof Julietta Patnick, director of the NHS Cancer Screening Programmes, welcomed the review: "The NHS Breast Screening Programme has always been based on the best and latest evidence. "Where new information has suggested them, a number of changes have been made to the Programme, for example extending the screening age range and using digital mammography." The review will be led jointly by Prof Richards and Cancer Research UK. The director of health information at the charity, Sara Hiom, said: "Women need more accurate, evidence-based and clear information to be able to make an informed choice about breast screening. "The decision whether to be screened is a personal one, but that decision should be made with all of the potential harms and benefits fully explained." Breakthrough Breast Cancer's chief executive Chris Askew said: "Breast screening is vital as it can detect breast cancer at the earliest possible stages when no other symptoms are obvious. "The earlier breast cancer is picked up the better for the one in eight women who are diagnosed every year with this disease, as treatment options are more likely to be less aggressive and have successful outcomes."
The men who ate the most eggs were at a higher risk
“Eating just three eggs a week increases chance of men getting prostate cancer,” reported the Daily Mail. The story went on to say: “Experts in the US claimed that men who consume more than two-and-a-half eggs on a weekly basis were up to 81% more likely to be killed by the disease.”
This research examined the association between eating red meat, poultry and eggs and the risk of developing lethal prostate cancer (which the researchers defined as either dying from the disease or having metastatic disease that had spread to other organs). The study was in a large group of 27,607 healthy men, of whom 199 developed lethal prostate cancer over 14 years of follow-up. The researchers calculated that the men who ate the most eggs were at a significantly higher risk than those who ate fewer eggs. No significant association was found with any other food item.
This large cohort study has some strengths, such as its large size and the fact that information on the participants’ diet was continually updated over the course of the study. However it also has several limitations, and only a small number of lethal cancers actually occurred, which could suggest that this association is due to chance. Furthermore, these results are inconsistent with previous research, which found no significant association between eggs and prostate cancer. The findings will need to be confirmed in more robust studies before any firm conclusions can be drawn.
Where did the story come from?
The study was carried out by researchers from the Harvard School of Public Health, the University of California in San Francisco, Brigham and Women’s Hospital and Harvard Medical School. Funding was provided by the US National Institute of Health.
The study was published in the peer-reviewed medical journal, Cancer Prevention Research.
The media generally reported the study accurately. However, the Daily Mirror’s suggestion that “a clear link between eggs and prostate cancer” has been found may be misleading, as the researchers say that their results contradict previous findings into the association and that more research is needed. But the Mirror does point out that men in the study who ate the most eggs differed from the rest of the participants in important ways, such as weight and smoking status.
What kind of research was this?
This was a prospective cohort study that investigated whether there is an association between eating red meat, poultry and eggs and the risk of developing lethal prostate cancer in healthy men. A subgroup analysis was carried out afterwards in the men from this cohort who went on to develop prostate cancer. The researchers wanted to see whether eating habits after a prostate cancer diagnosis were associated with the risk of the disease progressing and becoming fatal.
The researchers’ theory was based on the findings from previous research, which found:
an increased risk of developing lethal prostate cancer in healthy men who ate red meat
an increased risk of progression to lethal disease in men with prostate cancer who ate eggs and skin-on poultry after their diagnosis
Participants were recruited from an ongoing cohort study that began in 1986. This study was comprised of American male health professionals who were between the ages of 40 and 75 in 1986. Men in this study completed a questionnaire every two years with information on their medical conditions, physical activity, weight, medications and smoking status. They provided information regarding their eating habits every four years.
Prospective cohort studies are an appropriate design for answering this type of research question. Assessing eating habits at the beginning of a study reduces the risk that people will inaccurately recall their dietary habits, which can arise when you ask people to remember what they ate over a long period of time. It also ensures that the exposure (eating certain foods) precedes the outcome (developing and dying of prostate cancer).
What did the research involve?
In 1994, the researchers recruited 27,607 men from the existing cohort study in the US. The men did not have prostate or other forms of cancer (except non-melanoma skin cancers, which are rarely aggressove). They had also had a prostate specific antigen (PSA) test (PSA screening is not performed in the UK, as higher PSA levels can indicate cancer but are not specific for it. For example, raised levels can also occur with benign enlargement, infection or inflammation).
In this study:
Information on the men’s eating habits was collected every four years.
Information regarding prostate cancer diagnosis was collected every two years.
From men who had been diagnosed with prostate cancer, information of treatment and disease progression was collected every two years.
The researchers defined lethal prostate cancer as disease that had spread to distant organs (metastatic cancer) or death due to prostate cancer during the study’s follow-up period (1994 to 2008).
The researchers followed up the cohort for 14 years and analysed the associations between eating different amounts of red meat, poultry and eggs and the risk of developing lethal prostate cancer. The researchers grouped each participant according to the average amounts of each type of food they ate per week. For red meat, the subgroups included (per week):
less than three servings
3 to 4 servings
5 to 7 servings
over 8 servings
For poultry, the subgroups were defined as (per week):
less than 1.5 servings
1.5 to 2.5 servings
2.5 to 3.5 servings
over 3.5 servings for week
For eggs, the subgroups were:
less than half an egg
0.5 to 1.5 eggs
1.5 to 2.5 eggs
over 2.5 eggs
To determine which subgroup each participant would be allocated to, the researchers averaged their responses from all of the dietary questionnaires the participants had completed up until their diagnosis, or until the end of the study (for those who were not diagnosed).
To determine the amount of each food eaten, the researchers averaged the reported amounts over all of the questionnaires that were completed before diagnosis. During the analysis, the researchers controlled for possible confounding factors such as age, amount of food eaten, body mass index (BMI, which is an indicator of obesity), smoking status and physical activity levels.
The researchers also analysed the risk of dying from prostate cancer in the men who were diagnosed with it during the course of the study, based on their eating habits after diagnosis. The researchers only included men who were diagnosed with localised cancer (cancer that had not spread beyond the prostate). During the analysis, they controlled for possible confounding factors such as age at diagnosis, time since diagnosis, disease stage, treatment type, BMI, activity level, smoking status and pre-diagnosis diet.
What were the basic results?
Of the 27,607 men included, 199 died of prostate cancer during the study. When the researchers analysed the association between eating habits and risk of lethal prostate cancer when using data up to the point of initial diagnosis, they found that:
Men who ate an average of 2.5 or more eggs per week had an 81% higher risk of lethal prostate cancer compared to those who ate an average of less than half an egg per week (Hazard Ratio [HR] 1.81, 95% CI 1.13 to 2.89, p=0.01).
The association between average amount of eggs eaten per week and risk of lethal prostate cancer became non-significant when the researchers analysed data collected up to the point of development of a lethal form of the disease (that is, disease progression or death).
There was no significant association between the average amount of red meat eaten and the risk of lethal prostate cancer.
Men who consumed more red meat or eggs tended to exercise less and have a higher BMI, and were more likely to smoke and have a family history of prostate cancer.
Of the 3,127 men who developed prostate cancer during the course of the study, 123 died of it during follow-up. Further analysis of the men who died found no significant association between eating habits after diagnosis and risk of the disease progressing from localised prostate cancer to lethal prostate cancer.
How did the researchers interpret the results?
The researchers conclude that: “Eating eggs may increase risk of developing a lethal form of prostate cancer among healthy men,” and that although “additional large prospective studies are needed, caution in egg intake may be warranted for adult men”.
Conclusion
This was a large prospective cohort study that examined the impact of lifestyle on the risk of developing and dying of advanced prostate cancer.
In addition to its large size, another strength of the study is that the information regarding exposure (eating habits) and possible confounders (medical conditions, activity levels, weight, medications and smoking status) were continually updated over the study’s course. However, updating information on eating habits every four years may still introduce a significant level of recall bias, and accurately remembering what you ate over the previous four years is likely to be difficult.
The study and data analysis also has several limitations. First, the number of deaths and cases of lethal prostate cancer were small (only 199 out of 27,607 men in the whole cohort, and 123 out of 3,127 in the case-only cohort [those who initially developed localised disease]). This small number increases the likelihood that the results are due to chance. Second, the researchers say that the group of men included in the study generally ate low amounts of the foods of interest, which limits the "power" (or ability to detect a difference) of the analysis.
Furthermore, while the researchers controlled statistically for a number of possible confounders, it is difficult to say whether other factors could account for this relationship. The researchers say that men in the study who consumed more red meat or eggs tended to have a higher BMI, exercise less and were more likely to smoke and have a family history of prostate cancer. Additionally, it is probably difficult to control completely for other dietary effects and focus the analysis on a single component of a person’s diet.
This study points to possible associations between diet and risk of prostate cancer. The aforementioned limitations, however, weaken the strength of these conclusions, along with the fact that previous research has looked at this question and found no association. While an 81% increased risk sounds like a high and definitive figure, it is probably best to wait for more conclusive research before cutting eggs out of your diet. There are existing dietary and lifestyle guidelines for reducing cancer risk, such as limiting your consumption of energy-dense foods such as meat and increasing your consumption of fruits, vegetables and wholegrains.
Scans – like this one showing a lung tumour – are used to help diagnose cancers
