A new study1 that combines genetic information on bowel cancer with NHS patient outcome data has found a link between family history of the disease and a better chance of survival, published in the British Journal of Cancer.
Cancer Research UK scientists, based at the University of Leeds, in collaboration with the National Cancer Intelligence Network (NCIN), matched the genetic data2 of nearly 11,000 bowel cancer patients with data from the National Cancer Data Repository (NCDR) on treatment and survival.
And by tracking the survival of these bowel cancer patients they found that the 1,700 people (16 per cent) with a family history of the disease were 11 per cent less likely to die from bowel cancer within 5 years of diagnosis than patients who had no family history of the disease3.
The scientists believe the better prognosis for those with a family history may be linked to the fact that these patients were more likely to have right-sided tumours, that are biologically different to other tumour types, which may respond better to treatment.
Dr Eva Morris, a Cancer Research UK funded scientist at the University of Leeds, and lead author of the research, said: “Our study has found a relationship between family history of bowel cancer and a higher chance of survival.
“Although we haven’t been able to determine exactly why this is the case, it does demonstrate how we can use data that we already routinely collect to help us develop a better understanding of bowel cancer and its genetic causes.
“As datasets such as the NCDR expand and collect more detailed information this opens up the possibility of using this data to help develop better targeted treatments for patients, based upon their individual genetics.”
Dr Julie Sharp, senior science information manager at Cancer Research UK, said: “This is another important step forward in our understanding of bowel cancer. Now we need to find out more about what’s causing this difference. Studies like this, which link genetic data to detailed patient information, may help us develop a more personalised approach to treating cancer in the future.
“Survival from bowel cancer is best when it’s diagnosed and treated in the early stages, so anyone who notices possible symptoms of the disease – blood in stools, or changes to bowel habits lasting longer than three weeks should get this checked out. If you think you may have a family history of bowel cancer it’s worth discussing this with your GP.”
According to new data from the North-East of England, published in the British Journal of Cancer, patients whose disease was spotted via screening had a better chance of beating their disease than those diagnosed after developing symptoms.
This is great news, and shows that bowel screening can make a real difference.
It comes after a Scottish study last year found that bowel cancer death rates were cut by 27 per cent among those who had attended screening compared with those who did not.
But at Cancer Research UK, we’re not ones to rest on our laurels. Although the programme spotted some cancers, it missed others.
We can do even better. And we’ve had our thinking caps on to work out what Governments need to do to make the UK nations’ bowel cancer screening programmes even more comprehensive, and save even more lives.
The bowel cancer screening test offered in the UK uses a test called the faecal occult blood test, or FOBT. It’s done at home, and involves posting a series of stool samples off for testing. The test looks for the presence of traces of blood in the stools – which can be a sign of bowel cancer.
The test is offered every two years. But in terms of who is eligible, the devolved nations of the UK all operate slightly different screening programmes.
But across all four nations, only about half of those invited to participate actually do so.
We would like to see more people participate in the programme. This means more encouragement from GPs, from awareness campaigns and from peer-groups. We need people to know about the programme, and its benefits. Given how effective we now know bowel screening is, and that bowel cancer is among the most common cancers, even a small increase in uptake could make a big difference.
Researchers have invented a newer, better, simpler version of the screening test. It’s called ‘faecal immunochemical testing’, or FIT, and it doesn’t just detect whether blood is present or not, it detects the amount of blood present. This makes it more sensitive, and requires people to take fewer samples. Evidence suggests that it will also detect more cancers and pre-cancerous growths than FOBT.
It’s unlikely to be more expensive than FOBT, and evidence is emerging to suggest that introducing the FIT test will improve uptake.
So we want the UK’s governments to begin planning for a switch-over from FOBT to FIT right away.
In April 2010, a landmark trial, which we helped fund, showed that a single bowel screen using a tiny camera on a flexible tube (called a flexi-scope) could both prevent and detect bowel cancer. The test not only spots cancers, it can detect and remove pre-cancerous polyps.
In October that year, Prime Minister David Cameron announced that the test would be incorporated into the NHS’s bowel screening programme in England. This would then be followed by stool testing from age 60. This could make a huge difference to bowel cancer rates in the UK.
But 18 months later, we’re still waiting for clarification over where, when and how the programme will be rolled out. So we want to see two things:
This is absolutely crucial – not just for flexi-scope, but for the whole screening programme, and for spotting bowel cancer early. We’ve heard from experts in the field that the UK’s endoscopy services aren’t what they could be. But the recent Be Clear On Cancer awareness campaign increased the demand for endoscopies, as more people were referred by their GP with symptoms.
If the NHS is to properly implement flexi-scope screening as well, it needs to make sure it has a world-class endoscopy service – which means more trained and equipped endoscopists.
This is particularly true in England. Last year, the Westminster government earmarked an extra £450m, to be spent over four years, in part to improve endoscopy in the English NHS. But a recent survey by GP Magazine showed that only just over half of local health authorities were actively spending this cash. This needs to change.
We want the Westminster government to update plans for rolling out flexi-scope in the NHS in England and to ensure everything is in place so that they can move forward with implementation. And while high quality roll-out is the top priority, we need to see the detailed plans for how things will be kept moving.
In Scotland, Wales and Northern Ireland, we want the governments to start planning for and piloting flexi-scope. Currently, flexi-scope is proposed to be carried out at age 55. In Scotland, where screening begins at 50, the government will need to work out how to incorporate flexi-scope into their existing screening programme.
We want to stress – the existing bowel screening programmes are a success, and we would like to urge people to take part when invited. But we can’t be complacent. As more evidence emerges, we will continue to pressure our politicians to make sure the UK public are getting the very best bowel screening.
Physical activity and exercise protect against bowel cancer
Amidst the usual flurry of scare stories, it makes for a pleasant change of pace when we have a positive and scientifically strong study to report in the area of cancer prevention.
One such story appeared last week. A new study published in the British Journal of Cancer showed that keeping physically active – walking, running, taking part in sport, or manual work – can reduce the risk of bowel cancer.
By (quite literally) taking simple steps, both men and women could reduce their risk of colon cancer – the most common type of bowel cancer – by a quarter.
We’ve talked about this message elsewhere, but it’s worth restating here, especially because bowel cancer is the third most common cancer in the UK. It’s important for people to know what they can do to reduce their risk of developing it.
This new work was a comprehensive review of the existing scientific evidence, taking the results of 52 previous studies into account.
The researchers found that several different types of physical activity, from occupational activity like manual labour, to more traditional leisure-time activity such as running or going to the gym, can all reduce the risk of bowel cancer.
Cancer Research UK recommends that you try to take half an hour’s “moderate” physical activity a day, five days a week.
“Moderate” activity should be enough to leave you feeling warm and slightly out of breath. It doesn’t have to be strenuous, time-consuming or expensive – it can even include housework, gardening or walking briskly. In fact, a couple of studies included in the review even suggested that brisk walking is enough to reduce the risk of bowel cancer.
Why does being active reduce the risk of bowel cancer?
There are a few possible explanations and it could be one or a combination of these.
One or more of these theories could be correct. Perhaps all of them are. Either way, the benefits of physical activity are clear, and they have been established through a significant amount of research in large numbers of people.
The benefits of keeping active aren’t limited to bowel cancer either. We also know that breast cancer, and possibly womb cancer, are less common among physically active women.
So if you want some tips for becoming more active, have a look at our Exercise and activity pages. Alternatively, why not sign up for one of Cancer Research UK’s many running events, such as Race for Life or Run for Moore. You’ll be helping us to raise funds for vital research, while making a start at reducing your risk.
K Y Wolin, Y Yan, G A Colditz, I-M Lee (2009). Physical activity and colon cancer prevention: a meta-analysis British Journal of Cancer, 100 (4), 611-616 DOI: 10.1038/sj.bjc.6604917
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