Credit: Imperial science imagery
This weekend we’re celebrating our patron Her Majesty the Queen’s diamond jubilee. It’s amazing how much our world has changed since she came to the throne, when a pint of milk cost just sixpence in old money (2.5p today) and the idea of a portable pocket telephone was laughable.
In terms of cancer diagnosis, treatment and survival, the picture has changed almost beyond recognition.
In the 1950s, survival from cancer was poor. Damaging surgery and relatively unsophisticated radiotherapy were the main treatments, assuming the disease was detected in time for anything to be done. Today’s diagnostic tests, keyhole surgery, highly targeted radiotherapy and arsenal of cancer drugs were far beyond the imagination of the doctors at that time.
Similarly, our understanding of cancer has transformed over the past 60 years, thanks to the discovery of the structure of DNA, the advent of chemotherapy, and solid evidence for the links between cancer and factors such as smoking or viruses.
While the rest of the UK is getting out the bunting, we thought we’d take a look at the progress in beating cancer over the past six decades, and show how our dedicated scientists, doctors and nurses have been involved along the way.
Progress in survival
Although the UK didn’t start collecting detailed cancer statistics until the 1970s, the figures that we do have tell us that survival for some of the most common cancers – including breast and bowel cancers – has more than doubled since the early 50s, when the Registrar General stated that cancer killed nearly as many people in a single year as all the men who were killed during the six years of the Second World War.
The chances of surviving most types cancer today in the UK are better than they have ever been, thanks to advances in diagnosis and treatment, although there are some cancers – such as lung, oesophageal and pancreatic cancer, as well as brain tumours – where we need to do much more.
At the same time, there are also more people getting cancer in the first place. This is mostly down to our ageing population, because the risk of cancer increases as we get older and more of us are making it to a ripe old age. There’s also the influence of lifestyle choices – more than four in ten cases of cancer in the UK are linked to tobacco, alcohol, diet, overweight, inactivity, infection, radiation, occupational hazards, post-menopausal hormones or not breastfeeding.
Let’s not forget that we wouldn’t know any of this without statisticians and epidemiologists. Their diligent data-gathering and number-crunching over the past 6 decades has provided vital information about all aspects of cancer, from revealing important causes and risk factors to shaping the way that patients are treated.
Progress in detecting cancer
Back in the 1950s, the only way doctors could see inside the body was with X-rays, and there were no screening tests for cancer. Since then, we’ve seen huge leaps in imaging technology, including medical ultrasound in the 50s and CT, PET and MRI scanning in the 70s.
We now also have screening tests for several different types of cancer. Cancer Research UK’s work helped to shape the national screening programmes for breast, bowel and cervical cancer, which together save thousands of lives every year. And our researchers are working hard on screening tests for other diseases, including ovarian and oesophageal cancer.
Progress in understanding cancer
In 1953, James Watson and Francis Crick discovered the structure of DNA, kick-starting a revolution in molecular biology that fundamentally changed our understanding of cancer forever.
We now know that cancer is driven by faulty genes and molecules – faults that may be inherited or simply accumulate during a person’s lifetime. Out of the 30,000 or so genes that make up our genome, a large number of these have been linked to cancer, and new candidates are being discovered all the time.
This is just the beginning though, and we’re only just starting to understand the enormous, complex networks of genes, proteins and other molecules that drive cancer’s development. And it’s only recently become clear quite how cancers ‘evolve’ within an individual patient, making the disease so difficult to cure.
Progress in cancer care
Over the past 60 years we’ve seen a huge change in how cancer patients are treated. In 1952 the NHS was just four years old, and there was little co-ordination in the way that cancer was treated.
This all changed in the 1970s when Cancer Research UK helped establish the first cancer medicine (medical oncology) departments in the NHS, bringing together doctors and researchers to push forward improvements in treatment. Today, cancer patients are usually looked after by teams that cover all aspects of their care, helping to ensure that each patient gets joined-up treatment. This has been one of the most important developments behind the increase in survival rates we see today.
It’s also essential to mention the hospice movement, which was set up by Dame Cicely Saunders in the 1960s to allow cancer patients to die with dignity and proper pain relief – something that had been sorely lacking. As well as advances in treatment, we should never underestimate the importance of the progress in symptom and pain relief, which has made a huge difference to patients’ quality of life.
Progress in surgery
Surgery has been the mainstay of cancer treatment for over a century, but there’s been big changes here too.
In the 1950s, it was widely believed that only ‘radical’ surgery – operations removing as much tissue as possible – was effective at controlling cancer. Over the years, surgeons have moved towards smaller and less damaging operations. In particular our researchers made important progress in showing that breast cancer surgery could be less extensive.
Today many tumours are removed without damaging nearby organs or nerves, and keyhole surgery is becoming more common.
Progress in radiotherapy
Radiotherapy has changed almost beyond recognition since the Queen took to the throne. Thanks to the pioneering work of our researchers in the 1920s and 30s, radiotherapy was already widely used to treat some cancers by the 1950s, but it was hard to target it properly without the technology we have today.
Thanks to advances driven partly by Cancer Research UK-funded clinical trials, radiotherapy is now being transformed into a cancer treatment for the 21st century, especially with further developments such as IMRT, IGRT, stereotactic radiotherapy or radiosurgery (usually known by the brand-names Cyberknife and Gammaknife) and proton beam therapy.
Progress in chemotherapy
Today’s cancer doctors have a huge arsenal of drugs at their disposal, but back then their cupboard would have been almost bare. The earliest chemotherapy drugs were first tested in the 1940s, and our researchers helped to develop chlorambucil, melphalan and busulphan in the 50s – drugs that are still used today.
We also had a hand in developing or trialling many other drugs that have helped to improve survival for countless patients, including cisplatin, carboplatin, and temozolomide.
And as well as discovering some of these drugs, we’ve funded an enormous amount of work looking at how best, and in which combination, to use them – so that patients get the most effective treatment with the fewest side effects.
Progress in targeted treatments
Thanks to six decades of progress in understanding the biological ‘nuts and bolts’ that underpin cancer, there are now several treatments that specifically target faulty molecules on or in cancer cells.
An early example of ‘targeted’ treatment was the hormone therapy tamoxifen, which our scientists helped to test and has saved the lives of thousands of women with breast cancer around the world. Newer hormone drugs have arrived too, such as aromatase inhibitors for breast cancer and – most recently – abiraterone for prostate cancer, which we helped to develop.
But this work really started to come to fruition in the 80s and 90s, as researchers around the world developed antibody-based drugs including rituximab (Mabthera), trastuzumab (Herceptin), cetuximab (Erbitux) and bevacizumab (Avastin).
The next generation of targeted drugs followed hot on their heels, starting with imatinib (Glivec), which targets a specific protein faulty in leukaemia cells. Our research helped to lay the foundations for the development of imatinib, which has changed the outlook for many patients. There are now many other similar drugs that are coming into the clinic, and we continue to fund groundbreaking work in this exciting area.
Although it’s not quite the single ‘magic bullet’ envisioned by the pioneers of chemotherapy back in the 1950s, targeted therapy has the potential to make a big difference to cancer survival in the future, hand in hand with advances in testing tumours to find the genetic faults that are driving them.
Progress in preventing cancer
Prevention is always better than cure, but you can’t prevent something if you don’t know what’s causing it.
Back in the 50s, scientists and doctors were unclear about what actually caused the genetic damage that led to cancer. Was it inherited or due to an infection? Was it something in our environment or our lifestyle?
Sixty years of dedicated research have shown that the causes of cancer are more varied and complex than we could have ever imagined.
Today, smoking is the biggest single preventable cause of cancer in the world, yet we need look no further than the depictions of smoking in TV shows like Mad Men to see how attitudes have changed since the 1950s.
Cancer Research UK scientists have helped to reveal the tragic toll of tobacco, and many countries around the world now have smoke-free legislation – in the UK this is partly thanks to the campaigning efforts of thousands of our supporters. We’ve also seen big changes in understanding of other lifestyle factors that contribute to cancer, including diet, bodyweight, alcohol, and UV radiation from the sun and sunbeds.
Our researchers have also played key roles in understanding how viruses such as human papillomavirus (HPV), Epstein-Barr virus (EBV) and Kaposi sarcoma virus (KSHV) cause certain types of cancer. In fact, up to a fifth of all cancers worldwide are caused by viruses and bacteria.
Progress in awareness
Perhaps the biggest change of the past 60 years has been in our attitudes. It’s no longer a disease to be mentioned in hushed tones, and increasing survival rates mean that more and more people are alive to share their story of beating cancer.
People no longer have to hide a diagnosis of cancer for fear of what others might think, and numerous celebrities have gone public with their personal stories. Fundraising events for cancer charities are commonplace, generating vital money for research, advocacy and support.
But, more importantly, we’ve also seen a big change in public awareness about the things that can cause cancer and the warning signs to look out for. We’re not there yet, but Cancer Research UK and our partners are working hard to improve early diagnosis of cancer by raising awareness of its symptoms amongst the public and health professionals.
And we continue to push for tougher controls on tobacco, such as through our campaign for plain packaging, The Answer is Plain.
Progress in the future
It’s almost impossible to imagine how much our world might change over the next 60 years, although it’s certain that the fight will continue to find more effective ways to prevent, diagnose and treat cancer – advances that will save many more lives and keep families together for longer.
The revolution in gene sequencing technology will uncover more about the biological mechanisms that drive cancer, revealing how we can pinpoint it with new therapies. We also hope that the tentative steps currently being made in immunotherapy will break into a run, providing powerful new ways to treat cancer.
We also expect radiotherapy to continue becoming more accurate, and for the latest advances in technology to become commonplace. And perhaps there are entirely novel approaches out there, just waiting to be discovered. But policy-makers and pharmaceutical companies need to make sure that patients can benefit from these advances by making them affordable and available to all.
We are working hard to find more effective ways to detect cancer earlier through better diagnostic tests, imaging, and screening programmes, which could save many tens of thousands of lives over the coming decades.
And as we understand more about the things that cause cancer, we hope that this will lead to ways to prevent the disease. Part of this will be providing information to help us make healthy choices that can reduce our cancer risk. But we also expect the genetic revolution to reveal more about how our genomes influence our cancer risk, leading to more personalised screening or prevention measures.
We want governments around the world will keep up the pressure on tobacco firms, continuing to bring in tough legislation to cut smoking rates and save millions of lives. Although stricter laws and persistent health campaigning have loosened the grip of the tobacco industry in the West, they have taken their trade elsewhere. China and Africa are their main targets, priming a tobacco timebomb that will explode into millions of cancer cases over the coming decades.
Finally, Cancer Research UK couldn’t have made any progress over the past six decades without the generosity of our supporters, for which we are extremely grateful. We don’t receive any government funding for our research, so we rely on public donations to enable our scientists, doctors and nurses to keep making breakthroughs now and in the future.
Support our lifesaving research now, and help us work towards the next 60 years of progress.