By 2020, Britain will see the sharpest fall in deaths from bowel cancer in its history, Cancer Research UK experts will tell a press conference today.
Leading bowel cancer specialists will tell the conference that the introduction of screening and improved treatment of bowel cancer, could save thousands of lives every year.
The news coincides with the start of Bowel Cancer Awareness Month and the tenth anniversary of the Bobby Moore Fund. The Fund has supported work that looks into ways of preventing and treating the disease since the 1966 World Cup winning captain’s death a decade ago from bowel cancer.
Bowel cancer is the second most common cause of cancer death in men and women in the UK, yet eighty per cent of bowel cancer cases can be treated successfully if caught at an early stage.
Dr Wendy Atkin, deputy director of the Cancer Research UK Colorectal Unit at St Mark’s Hospital, says: “Once bowel screening is made available, deaths from the disease will become less common and the disease will be more treatable. Currently only 40 per cent of patients survive for more than five years.”
The government is currently considering two screening options – Faecal Occult Blood Test (FOBT) and Flexible Sigmoidoscopy (Flexi-Scope).
Dr Lara Lipton is one of the Bobby Moore Fellows who received funding during the last decade. Her research is focusing on genes that increase bowel cancer risk.
Dr Lipton’s research identified the role of a gene that heightens peoples’ risk of a certain type of bowel cancer. In her study she found that a gene called MYH increases the risk of multiple bowel growths and bowel cancer. The results of the study were published in the New England Journal of Medicine1 in February 2003.
Up to 10 per cent of bowel cancers are due to hereditary factors – making genetic screening another viable method for early detection of the disease. Dr Lipton’s research may provide one of the genes targeted by genetic screening in the future.
Professor John Northover, director of the Cancer Research UK Colorectal Unit at St Mark’s Hospital and one of the UK’s top bowel surgeons says: “The biggest step forward in the next decade is likely to be screening – as a result we will see the number of people dying from this disease fall dramatically.
“Research at the molecular level should also provide us with powerful ‘finger-printing’ tools. These will help us predict more precisely the behaviour of individual tumours.
“This will allow us to do smaller operations without chemotherapy or radiotherapy for the early, ‘low aggression’ tumours, while precisely targeting increasingly powerful drugs at the more ‘high aggression’ tumours.”
The disease is most common in people over the age of 50, although younger people can still suffer from the disease. The symptoms of bowel cancer often go unrecognised and the cancer progresses to an advanced stage if untreated.
Awareness of bowel cancer has increased over the last decade, which has helped reduce the stigma attached to the disease.
Bowel cancer develops as a result of damage to genes within cells lining the bowel. It is not known precisely what causes this, but hereditary factors and diet make this damage more likely to occur. These are both key targets for research.
Dr Lesley Walker, Director of Information at Cancer Research UK says: “Bowel cancer is preventable. We expect that the introduction of an effective screening programme for bowel cancer will cause similar results to when the screening programmes were launched for breast and cervical cancer – early detection, early improved treatment and fewer deaths.”
- New England Journal of Medicine348 (9)
The Faecal Occult Blood Test (FOBT) tests for hidden blood in the stool and is a test for early cancer. Trials have shown that it cuts deaths from the disease by up to 20 per cent if used every 2 years from age 50.
A positive FOBT is followed by a colonoscopy or barium enema to confirm the diagnosis.
Flexi-Scope looks for benign growths in the lower part of the bowel – these growths can turn cancerous. Two thirds of all bowel cancers develop in this area of the bowel.
STATS AND SYMPTOMS
Many of the symptoms of bowel cancer are common and may have a less serious explanation, but persistent symptoms should be reported to your doctor:
- bleeding from the back passage (the blood may look red or black and can appear mixed with faeces or on its own)
- mucus in the stool, combined with a change in bowel habit
- persistent change in bowel habit
- stomach ache that won’t go away or comes and goes in waves
- a lump or swelling in the abdomen
- unexplained weight loss.
Latest figures from Cancer Research UK show that in 1999 there were 34,661 British cases – an increase of 4000 per year compared with a decade ago. During the same decade however, British deaths dropped by 3,300 per year to 15,764.
THE BOBBY MOORE FUND
The Bobby Moore Research Fellowships are awarded on a competitive basis to ensure that only the very best scientists are chosen. Since the Bobby Moore Fund was founded in 1993 over £2 million has been raised, which has supported nine Bobby Moore Research Fellowships across the UK. The tenth will be awarded this year.
The money raised has funded the following projects:
- The CORGI study, which aims to identify genes that predispose individuals to bowel cancer
- Helping families with a history of bowel cancer
- Identifying the right drug for the right patient
- Studying why your diet makes a difference
- Targeting bowel cancer cells that have spread to the liver
- Searching for bowel cancer genes
- Developing a gene therapy approach for treating bowel cancer
- Studying how a recently discovered bowel cancer predisposition gene causes tumours in patients.
In addition, the Bobby Moore Fund has funded vitally needed equipment for the Family Cancer Clinic at the Colorectal Cancer Unit, St Mark’s Hospital, London.
KEY DEVELOPMENTS OF THE LAST DECADE
Screening was shown to be an effective method of reducing the number of deaths and new cases of bowel cancer. Cancer Research UK funded the trial of Faecal Occult Blood testing which is now complete. Cancer Research UK and the MRC funded the Flexi-Scope screening trial, which is expected to report results next year.
The APC gene was cloned in 1991. (In the mid-1980s, Sir Walter Bodmer and Ellen Solomon identified the location of the APC gene). Mutations in this gene causing familial adenomatous polyposis, FAP, which is most common inherited predisposition. Importantly, the gene is also involved in most sporadic cases of bowel cancer. APC codes for a protein with an important role in tumour formation. Other important genes in bowel cancer development include KRAS, TP53 – co-discovered by Professor Sir David Lane – and SMAD4.
Up to 80 per cent of bowel cancer cases are thought to be related to diet. In the early 1990s the European Prospective Investigation of Cancer (EPIC) study was launched to better understand diet’s effects on cancer. EPIC recruited 400,000 from 10 European countries, with Cancer Research UK funding the UK study. In 2001 preliminary results showed that a varied diet, rich in vegetables and fruit and low in processed meats may help protect against bowel cancer.