In our latest Rising to the Challenge virtual event, BBC journalist Jane Hill spoke with leading authorities on early detection research: the deputy director of our Cancer Research UK Manchester Institute, Professor Caroline Dive, the co-lead of the Early Detection Programme at our Cambridge Centre, Professor Rebecca Fitzgerald, and honorary consultant in clinical genetics at our Cambridge Centre and advanced clinician scientist, Dr Serena Nik-Zainal. Their objective? To remind us all that while research has been hindered by the pandemic, finding ways to detect cancer earlier simply can’t wait. Here, Eddie Bowers captures the highlights from the discussion.
BBC journalist Jane Hill kick-started the discussion with a stark fact: “For some cancers, survival is more than three times higher when the disease is diagnosed early, while treatment is usually easier and cheaper.” Despite this, nearly half of all cancer patients in England are diagnosed when the disease is already at an advanced stage.
Early detection in the blood
The first of our speakers, Professor Caroline Dive, is the co-lead for our Lung Cancer Centre of Excellence at our Manchester Institute. She’s developing blood tests to improve our ability to detect lung cancer at an earlier stage. “What we’ve found with lung cancer quite recently is that, even in early stage-one cancers, some cells break away and get into the blood stream early,” she explained. “This means there can be an early detection test”. By using sophisticated technology, Caroline and her team are identifying, isolating and sequencing these cells to gain a better understanding of their biology.
Caroline is keen to add blood testing to the current screening for early detection of lung cancer in socially deprived areas, and has contributed to the testing effort in North Manchester. She believes that if we access these communities – where people often don’t see their GP until it’s too late – take a blood sample and perform a scan, “we can then interrogate that sample and have a lot more confidence in saying that the patient should be referred”. This would mean that diagnosis and treatment could happen earlier, improving a person’s chances of survival. Of course, none of this is easy or cheap. “We need to know more about the biology of what’s happening in the bloodstream,” Caroline continued. “But to discover this, we need big multi-disciplinary teams and sustained funding – it’s not just the technology that’s expensive, it’s also the size of the experiment that we’d need to do.”
‘Sponge on a string’
Our second speaker, Professor Rebecca Fitzgerald, has spent her whole career focusing on early detection because she knows how vital it is to improving outcomes for patients. As a gastroenterologist, a lot of her work is focused on oesophageal cancer – rates of which have increased dramatically in the past 30 years. With only 12% of people surviving for 10 years or more, early detection of oesophageal cancer is a priority for Rebecca. Hard-to-treat cancers like this one are also a key priority area for Cancer Research UK, which is why we’ve supported Rebecca’s important work for the past decade.
Rebecca reminded listeners that the main risk factor for oesophageal cancer is persistent heartburn – a common complaint – and the main symptoms are difficulty swallowing and weight loss, which only become apparent in the late stages. Here we begin to see the scale of the early detection problem. How do we identify the people at a greater risk of developing cancer when the symptoms could be attributed to any number of benign health complaints? During the discussion, Rebecca discussed her revolutionary solution, the Cytosponge-TFF3 test, recently trialled in the clinic with excellent results. The simple test can be performed by a GP in 10 minutes and involves swallowing a dissolvable pill on a thread which expands into a small sponge when it reaches the stomach. When it’s gently pulled back up, the sponge collects some of the cells lining the oesophagus on its way which can be analysed in the lab.
Rebecca is also the co-lead of our Alliance for Cancer Early Detection (ACED), a £55m international partnership between five centres of research excellence, with a bold ambition to accelerate and revolutionise research in the early detection of cancers. As we heard during the discussion, this will be a monumental research challenge but Rebecca strongly believes, “when you bring people together from different institutions, with different expertise in different disciplines, they can really spark off each other and develop new ideas”.
Caroline echoed Rebecca’s optimism: “It’s exciting to set up these international collaborations and to learn from other centres,” she said. “It all comes down to multi-disciplinary teamwork.”
Our third panellist was Dr Serena Nik-Zainal, a Cancer Research UK-funded advanced clinician scientist. Serena and her team at our Cambridge Centre read cancer genomes – the complete set of a group of cancer cells’ DNA – to understand why a cancer has developed. “It turns out that the DNA in cancers are highly disorganised and mutated,” she mused. “These mutations arise as a consequence of the cell changing from a normal cell to a cancer cell, so they document why something has turned into a cancer.” The human genome – described by Serena as an “archaeological record” – is enormous and so we need computers to help us read them. By accelerating the process, thinks Serena, we can identify which mutations to target with specific therapies and which drugs a tumour may be sensitive to. Serena hopes that alongside aiding early diagnosis, interpreting the genome could help us distinguish between malignant and benign tumours.
As a recipient of the Cancer Research UK advanced clinician scientist fellowship, Serena was keen to tell listeners about how this has enabled her work. “You can have ideas, but you need the funds to be able to implement them and test them out. When you fund a clinician scientist you’re investing in the development of their scientific ideas,” she said.
“I made the UK my home because of the opportunities provided by these fellowships. Our work just couldn’t have happened without the scheme.”
Serena is also working on an exciting Grand Challenge, as part of our landmark Cancer Grand Challenges programme. Find out more about her work here.
Supporting early detection
Following the stimulating conversation from our early detection experts, Jane introduced Simon Eyers, a generous Cancer Research UK donor supporting early detection research at our Cambridge Centre. Simon shared his cancer experience and made a powerful case for supporting our work: “We brush our teeth so we don’t get gum disease, we put our seatbelt on in case we crash our car, we buy home insurance in case our house burns down, yet none of those things are as likely to happen to us as getting cancer. 1 in 2 of us will get cancer at some point in our lives, so we should feel obliged to help drive progress in cancer research. By supporting Cancer Research UK, the largest independent funder of the highest quality cancer research, we can play our part.”
Caroline agreed that research has never been more important, particularly in the early detection space: “We shouldn’t forget that people are still getting cancer and we need to focus our efforts. And we need to have funds coming in to support early detection research,” she said. “The health of the public will be transformed if we get early detection of cancer right.”
Listen to the virtual event here.
By Eddie Bowers, philanthropy communications executive