Study claims some cancers 'better left undiscovered'

[Leongsam]

Study claims some cancers 'better left undiscovered'
Liam Mannix13:23, Jan 27 2020





The impact of a cancer diagnosis

When 26-year-old Katharina was diagnosed with an aggressive form of breast cancer, it turned her life upside down. But she did her best to stay positive.
A controversial new study claims about one in every five cancers diagnosed in Australia would have been better left undiscovered.

The study, published in the Medical Journal of Australia on Monday, argues more than half of melanomas, 22 per cent of breast cancers and 42 per cent of prostate cancers diagnosed in Australia would never have caused problems.

JEMS STEM A prostate cancer cell. The Australian study team has proposed two solutions to the overdiagnosis of cancer.

The government funds a breast-cancer screening program and many people diligently ask their GP for skin and prostate cancer checks.
But all that extra checking is turning up cancers that would never have gone on to harm the patient, the study says.



The model and body positivity advocate says she "knew that surgery would be life changing but I never knew it could change my life in such a positive way".

READ MORE:

* Chasing the ultimate dream: Kiwi scientists work on breast cancer vaccine
* Cervical screening 'needs to be part of everyday conversation'
* Cancer blood tests 'very close', as scientists develop the technology
* Why are Kiwi men in some regions twice as likely to die of prostate cancer?

And to treat them, we turn to surgery and chemotherapy – which come with their own risks.

"There will be cancers diagnosed that will not go on to be life threatening," concedes Cancer Council CEO Professor Sanchia Aranda.

"But the issue remains that we don't always know which cancers are overdiagnosed and which cancers pose a real threat.

"Not diagnosing a cancer and having a woman die would be considered a bigger harm that the damage of getting a cancer diagnosis that was of a cancer that might not have harmed you."

To come up with the calculation, the Bond University-led team compared cancer rates between 1982 and 2012 - a time in which our cancer incidence rate rose by about 30 per cent while our cancer death rate fell.

They studied only five cancers which are known to be overdiagnosed: breast, prostate, renal and thyroid cancer and melanoma.

After adjusting for risk factors that had changed over the years, the researchers concluded much of the increase in cancer could be explained by doctors finding more harmless cancers.

Assuming that other cancers were not being overdiagnosed - which may or may not be the case - they came to a final figure of 18 per cent of all cancers in women, and 24 per cent of those in men, being overdiagnosed.

Breast cancer screening is a particularly difficult case because doctors often cannot tell if the cancer they find will be harmless or life threatening. To be safe they treat them all the same: with surgery or chemotherapy.

In the UK, women receive a leaflet before they get their mammograms.

For every 200 women screened, one will have her life saved, the leaflet says. But three will undergo unnecessary surgery for a cancer that never would have caused symptoms.

Ultimately, "it is your choice," the pamphlet concludes.

British Medical Journal editor Fiona Godlee is among high-profile scientists who weighed those odds and decided to skip screening.

"I struggle with it, I really, really struggle with it," says Professor Alexandra Barratt, one of the study's authors and a breast-cancer screening researcher at the University of Sydney.

"There are potential benefits and potential harms – and I am very concerned about the risk of being overdiagnosed and overtreated."

Bond University's Professor Paul Glasziou led the study. He says an explosion in skin cancer screening has led to huge numbers of harmless moles being cut out. Some of that may be driven by financial reasons; look at the number of new mole-screen clinics appearing, he says.

And prostate cancer is overdiagnosed. The Royal Australian College of GPs now recommends against prostate cancer screening.

"I'm 65, there is about a 50 per cent chance that if you sliced up my prostate you'd find cancer," Professor Glasziou says. "And the vast majority of those would not cause a problem in a person's lifetime."

The study team proposes two solutions to overdiagnosis: research to develop better tests for cancer, and information campaigns – like the one in the UK – to warn people of the pros and cons of screening.

A 2015 study on 879 women in the state of New South Wales found when they were told about overdiagnosis risks, only about 74 per cent planned to get screened. In women who were not told, that number was 87 per cent.

Sydney Morning Herald

 

[syed putra]

Immune discovery 'may treat all cancer'
By James GallagherHealth and science correspondent

• 20 January 2020
• 136comments

• Share this with Facebook
• Share this with Messenger
• Share this with Twitter
• Share this with Email
• Share

Image copyrightSCIENCE PHOTO LIBRARYImage captionThe new technique could kill a wide range of cancer cells, including breast and prostate
A newly-discovered part of our immune system could be harnessed to treat all cancers, say scientists.
The Cardiff University team discovered a method of killing prostate, breast, lung and other cancers in lab tests.
The findings, published in Nature Immunology, have not been tested in patients, but the researchers say they have "enormous potential".
Experts said that although the work was still at an early stage, it was very exciting.
What have they found?
Our immune system is our body's natural defence against infection, but it also attacks cancerous cells.
ADVERTISEMENT

The scientists were looking for "unconventional" and previously undiscovered ways the immune system naturally attacks tumours.
What they found was a T-cell inside people's blood. This is an immune cell that can scan the body to assess whether there is a threat that needs to be eliminated.
The difference is this one could attack a wide range of cancers.
"There's a chance here to treat every patient," researcher Prof Andrew Sewell told the BBC.
He added: "Previously nobody believed this could be possible.
"It raises the prospect of a 'one-size-fits-all' cancer treatment, a single type of T-cell that could be capable of destroying many different types of cancers across the population."
How does it work?
T-cells have "receptors" on their surface that allow them to "see" at a chemical level.
The Cardiff team discovered a T-cell and its receptor that could find and kill a wide range of cancerous cells in the lab including lung, skin, blood, colon, breast, bone, prostate, ovarian, kidney and cervical cancer cells.
Crucially, it left normal tissues untouched.

Image copyrightSCIENCE PHOTO LIBRARYImage captionT-cells attack cancer cells
Exactly how it does this is still being explored.
This particular T-cell receptor interacts with a molecule called MR1, which is on the surface of every cell in the human body.
It is thought MR1 is flagging the distorted metabolism going on inside a cancerous cell to the immune system.
"We are the first to describe a T-cell that finds MR1 in cancer cells - that hasn't been done before, this is the first of its kind," research fellow Garry Dolton told the BBC.

• Cancer treatment trial: Chemotherapy 'could become more effective'
• 'Cancer treatment broke my heart, but I've survived'
• New cancer treatment to tackle drug resistance

Why is this significant?
T-cell cancer therapies already exist and the development of cancer immunotherapy has been one of the most exciting advances in the field.
The most famous example is CAR-T - a living drug made by genetically engineering a patient's T-cells to seek out and destroy cancer.
CAR-T can have dramatic results that transform some patients from being terminally ill to being in complete remission.
However, the approach is highly specific and works in only a limited number of cancers where there is a clear target to train the T-cells to spot.
And it has struggled to have any success in "solid cancers" - those that form tumours rather than blood cancers such as leukaemia.
The researchers say their T-cell receptor could lead to a "universal" cancer treatment.
So how would it work in practice?
The idea is that a blood sample would be taken from a cancer patient.
Their T-cells would be extracted and then genetically modified so they were reprogrammed to make the cancer-finding receptor.

The upgraded cells would be grown in vast quantities in the laboratory and then put back into the patient. It is the same process used to make CAR-T therapies.
However, the research has been tested only in animals and on cells in the laboratory, and more safety checks would be needed before human trials could start.
What do the experts say?
Lucia Mori and Gennaro De Libero, from University of Basel in Switzerland, said the research had "great potential" but was at too early a stage to say it would work in all cancers.
"We are very excited about the immunological functions of this new T-cell population and the potential use of their TCRs in tumour cell therapy," they said.
Daniel Davis, a professor of immunology at the University of Manchester, said: "At the moment, this is very basic research and not close to actual medicines for patients.
"There is no question that it's a very exciting discovery, both for advancing our basic knowledge about the immune system and for the possibility of future new medicines."

 

[syed putra]

Here is the problem if you are diagnosed with a late stage cancer and undergo agressive radiotherapy/ chemo therapy.
The original cancer maybe cured, but the body immune system will be so weak to defend from another form of cancer that may appear elsewhere to ultimately consume the patient.

 

[nayr69sg]

Here is the problem if you are diagnosed with a late stage cancer and undergo agressive radiotherapy/ chemo therapy.
The original cancer maybe cured, but the body immune system will be so weak to defend from another form of cancer that may appear elsewhere to ultimately consume the patient.

Also the aggressive therapy kills normal cells and if the body is too weak to recover from the overall damage the patient dies earlier.

My brother in law recently had an aunt who had cancer. Apparently they were told that if she wanted to stay in Mt E they had to try some chemotherapy otherwise the insurance won't cover her stay. She was not keen on chemo but because of the insurance rules she tried it. She passed away the same week.

 

[mojito]

Also the aggressive therapy kills normal cells and if the body is too weak to recover from the overall damage the patient dies earlier.

My brother in law recently had an aunt who had cancer. Apparently they were told that if she wanted to stay in Mt E they had to try some chemotherapy otherwise the insurance won't cover her stay. She was not keen on chemo but because of the insurance rules she tried it. She passed away the same week.

The winner is insurance co, another liability crossed out of their books.

 

[nayr69sg]

The winner is insurance co, another liability crossed out of their books.

Private health insurance is so bad for healthcare. People just don't realize it.

Unfortunately, lay people don't really understand what is good practice of medicine.

If a doctor tells you that the chances of remission from cancer is very unlikely and it is terminal and advises palliative care you will curse the doctor!

On the other hand a doctor who says let's try chemotherapy. If we don't try you condemn your loved one to death. If we try there is a chance no matter how slim.

Insurance company says yes yes I will pay for the chemo but not the palliative therapy.

Patient takes the chemo in her weakened state and dies a few days later.

Surprisingly the family says it was worth the try. Too bad.

Insurance company crosses out one less liability. Pays for the chemo and saves on the palliative cost which would have been higher which they have already from the outset say they will not cover. It is almost a form of painful assisted suicide.