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NCRI Sunday lectures – bookmarks, blood vessels, dignity, and the real cause of breast cancer

by Henry Scowcroft | Analysis

6 October 2008

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Sunday afternoon at the NCRI conference was packed with talks from some of the world’s leading cancer experts.

Kat’s already blogged about Michel Coleman’s public lecture on cancer survival in the UK versus Europe, and we’ll be bringing you more in-depth posts about some of the main sessions once we’ve written them up.

But for now, here’s a taster of Sunday’s plenary sessions.

Molecular ‘bookmarks’

The scientific talks were kicked off by Cancer Research UK’s Professor Tony Kouzarides from the University of Cambridge. He’s one of the world’s leading experts in histone modifications – the molecular ‘bookmarks’ that are stuck onto proteins called histones, that package DNA.

These bookmarks play a vital role in ensuring that cells ‘know’ which of their genes should be switched on, and which should be turned off. Of course, this is very important in cancer, as patterns of gene activity go haywire as the disease develops.

Professor Kouzarides described recent work by his team uncovering two new types of histone modification that may be implicated in cancer. These findings could potentially point to new targets for anti-cancer drugs. But, as Professor Kouzarides pointed out, there are many different types of histone modification at work in our cells, so it’s likely that drugs that affect them will need to be given in combination.

Although the field of histone modification seems complicated, it’s a fascinating area of biology, and one that could potentially yield powerful anti-cancer drugs in the future.

Targeting tumour blood vessels

Professor Rakesh Jain, Professor of Tumour Biology at Harvard Medical School in the US, has been studying how blood flows around tumours – and how this can be exploited in cancer treatment – since the 1970s.

He’s just finished a series of clinical trials, the results of which suggest that the cutting edge drugs developed to cut off a tumour’s blood supply – so-called ‘angiogenesis inhibitors’ – actually work in a very different way.

According to Professor Jain, these drugs, which include Avastin, actually repair the disordered, chaotic network of capillaries within a tumour, increasing blood flow and allowing chemo- and radiotherapy to be much more effective.

If he’s right, it could mean that these drugs may be used far more effectively than currently recommended, with potentially fewer side effects, as they may only need to be given for short time at the beginning of treatment. It’s a controversial idea, and one that’s sure to be a hot topic over the next few years.

Edit – we’ve now added a longer summary of this talk here

Dying with dignity

After Professor Jain’s highly technical talk, we heard from Canadian clinical psychiatrist Professor Harvey Chochinov. He’s interested in a completely different, highly emotive, but no less vital area of research – the psychology of dying.

As we’re all too aware, sometimes cancer treatments just don’t work – and the focus of medical care switches to alleviating pain and suffering during the last months and weeks of life. A hugely important part of this care involves ensuring that people with terminal cancer can pass away comfortably and with dignity.

Yet few studies have actually sought to asses what ‘dignity’ means in this context, how it can be measured, and what can be done to safeguard it.

Professor Chochinov has conducted pioneering work in this field. His group has defined a series of recommendations for how doctors should act and behave when dealing with terminally ill patients. And their work has deepened our understanding of what ‘dignity’ is – and how ‘dignity care’ can be just as important as pain relief when facing the inevitable.

The real causes of breast cancer

The focus then shifted all the way back to the other end of the cancer spectrum – from mortality to cancer prevention. Cancer Research UK’s Professor Valerie Beral gave a fascinating, illuminating and thought-provoking talk on why developed, Western nations have far higher rates of breast cancer than developing populations.

Drawing on an immense volume of data, from studies of Italian nuns in the 1780s, all the way up to large-scale present day clinical trials, Professor Beral showed how changing lifestyle patterns of late childbirth and low breastfeeding rates – rather than ‘environmental’ causes – were the root cause of the high rates of breast cancer we see in the West. This is the main reason why these rates are climbing around the world as women round the world adopt a Western lifestyle.

Her analysis throws up an interesting conundrum. Given that modern women are unlikely to revert to having lots of children at a young age any time soon, what can be done to reverse this trend?

Professor Beral believes that the evidence points to some sort of hormone-driven ‘event’ in late pregnancy that permanently alters breast tissue and gives women life-long reduction in breast cancer risk for the rest of their life. If researchers can work out exactly what this is, and ‘bottle it’, it might be possible to protect women against breast cancer by giving them a one-stop treatment in their early adolescence.

It may seem far-fetched, but Professor Beral believes that anyone who can unpick the true nature of breast cancer will be in line for a Nobel prize. A hefty challenge indeed.