Postcode lottery

A real problem
Patients in Herefordshire are more than three times more likely to die within a year of diagnosis of lung cancer compared with patients in Kensington and Chelsea, according to the progress report published by the Department of Health.
Cancer Research UK called for urgent action from the Government, adding that there was “no excuse” for the differences in life expectancy between different areas.
The second annual progress report on the Cancer Reform Strategy comes after Mike Richards, the National Cancer Director, estimated that late diagnosis of cancer causes at least 10,000 premature deaths a year.
In an article for the British Journal of Cancer, Professor Richards writes: “These delays in the patient presenting with symptoms and cancer being diagnosed at a late stage inevitably costs lives.
“The situation is unacceptable so the first big step has been to understand why the delays occur.”

Patients not being treated / diagnosed early enough
Every year more than 290,000 people in Britain have some form of cancer diagnosed, and about 150,000 people die.
But while eight out of ten patients with bowel cancer live for more than a year after diagnosis in Telford and Wrekin in the West Midlands, less than six out of ten (57.9 per cent) do so in Waltham Forest, North London.
Ninety-nine per cent of all patients in Torbay, Devon, survive at least a year after a diagnosis of breast cancer, but this figure is 89 per cent in Tower Hamlets.
Harpal Kumar, chief executive of Cancer Research, said: “These shocking statistics confirm that the cancer postcode lottery remains a real problem.
“Patients are undoubtedly not being diagnosed early enough in large parts of the country, nor are they getting equal access to the best treatments, such as surgery for lung cancer.
“It’s a disgrace that such a small proportion of primary care trusts have survival rates that match the best figures in Europe, or even the best rates in Europe ten years ago.
“This needs urgent action.”

A lack of proper diagnostic tests and understanding of symptoms
A separate report by MPs on the All Party Parliamentary Group for Cancer, also published today, suggests that older patients may also be at risk of dying earlier due to a lack of proper diagnostic tests or symptoms.
Mark Simmonds, MP, a Conservative health spokesman, said: “We are concerned by this data, which demonstrates the unacceptable inequalities in treatment and care for cancer patients. In 2000 the Government pledged that reducing health inequalities was a key aim, yet nearly a decade on the gap has widened and five-year cancer survival rates still lag behind those of comparable European countries.”

Andy Burnham’s pledge
Andy Burnham, the Health Secretary, responded: “Cancer treatment in Britain has improved vastly in recent years and this is shown in the falling mortality rates and increasing survival rates.
“However, we know that survival rates vary across the country, particularly in deprived areas, so this year’s report has deliberately focused on local variations so we can highlight to the NHS where they need to take action.
“I hope that the publication of this data combined with the Prime Minister’s pledge to give patients key diagnostic tests within just one week of seeing their GP will save thousands more lives.”

The treatment
An invisible knife that uses high-intensity sound waves to penetrate the body and destroy tumours is set to revolutionise cancer treatment, it is claimed.
In five to 10 years ultrasound could replace conventional surgery and radiotherapy for patients with many different types of cancer, scientists said.

About the technique
The technique is undergoing early trials for liver and kidney cancer in the UK while a French team using a different system has already achieved disease-free results treating men with prostate cancer.
In China, where the technology has been pioneered, anecdotal evidence from studies of thousands of patients is said to be “astounding”.
Ultrasound surgery focuses bursts of high energy sound waves on the tumour, heating it to a temperature of 60 degrees Celsius. The tumour cells are destroyed while surrounding tissue is left unharmed.
Professor Gail ter Haar, who is leading trials of an experimental system at the Royal Marsden Hospital in Sutton, Surrey, England, said the technique could treat tumours up to the size of a small orange.

Testing ultrasounds
At this stage the trials are confined to testing the safety of the technique, but Prof ter Haar said they had already yielded “really exciting results”.
She told the American Association for the Advancement of Science’s annual meeting in Seattle yesterday: “I think there will be cancers for which it will revolutionise treatment, but we’re a long way from knowing which they will be, and exactly how it should be employed”.

What is treatment?
Patients with liver and kidney cancer are taking part in the Royal Marsden studies.
Treatment consists of two-second long bursts of ultrasound delivered to the surface of the body by a machine mounted on a gantry.
A number of bursts are needed to clear an organ of cancer.

Testing accross the world
At a different centre in Oxford, England, Prof ter Haar has been using a commercial device developed in China to treat a similar group of patients.
She has worked with Chinese physicians who have already treated about 3,000 cancer patients with ultrasound.
Although the Chinese trials were not as scientifically rigorous as those in the UK, the anecdotal evidence was impressive.
“The results in China are really quite astounding,” said Prof ter Haar.
“There are patients who are disease free with tumours for which there are no other treatments, particularly in the pancreas.”
She said that theoretically, ultrasound should be suitable for a wide range of solid tumours.
“If you can image a tumour with diagnostic ultrasound you should be able to treat it,” she told the meeting.

Not all cancers can be targeted with ultrasound
However, since the sound beam could not travel through bone or air, certain cancers would be difficult to treat.
Brain tumours and lung cancers deep behind the rib cage fell into this category.

Thinking about the tough cancer areas
Scientists in the UK and United States were working on the problem of getting ultrasound into the brain.
“Its very appealing for the brain because it’s a trackless form of damage,” said Prof ter Haar.
“You only get damage at the focus so you don’t damage the rest of the brain through which you’ve got to travel. If we could solve that problem it would be very exciting.”

Different applications and challenges of ultrasound
Dr Jean-Yves Chapelon from the French research institute Inserm in Lyon described a different ultrasound system now at an advanced stage of development which he had used to treat 242 men with prostate cancer.
The results were due to be published in the next few months.
Dr Chapelon said the treatment was as effective as conventional surgery or radiotherapy, and safer.
In this case the ultrasound beam was delivered through the rectum. After five years of followup, 80 per cent of low-risk patients were found to be disease-free and effectively cured.
For medium-risk patients the success rate was 60 per cent and for patients with high-risk aggressive cancers, 50 per cent. The men had an average age of 71.
Traditional treatments for older men with prostate cancer carry a high risk of impotence and urinary incontinence, but 40 per cent of the patients recovered their potency and only eight per cent were unable to control their urine flow.

Impressive results
Not one patient had died of cancer although the first was treated as long as 11 years ago.
“We believe that this therapy challenges other therapies,” said Dr Chapelon.
However, he said that at present it was still difficult to convince specialists that ultrasound therapy could be as good as conventional treatment.
Prof ter Haar said there was still much work to do before ultrasound became universally available as a cancer treatment.
She expected the process of patient trials, publication of data, and introduction into hospitals to take between five and 10 years.

Other applications for ultrasound
Another possible application of ultrasound might be on the battlefield, according to Dr Shahram Vaezy, from the University of Washington in Seattle.
His team was working on miniaturising ultrasound equipment that could be used to treat wounded soldiers, or accident victims.
A big advantage of ultrasound was that it had the ability to stop bleeding by sealing broken blood vessels, he said.
Dr Vaezy told the meeting: “The application we are pursuing is treating internal bleeding, to develop a non-invasive method of treating patients at the scene of an accident, for example”.

Here is a list of eight foods you should add to your diet in order to add years to your life :

1. Garlic
Garlic is a nutritional superstar that adds a wealth of taste to dishes without adding excess calories. Allicin, which is responsible for garlic’s strong smell and biting flavor, is an extremely potent antioxidant, and research published by the National Academy of Sciences shows that eating garlic appears to boost the body’s natural supply of hydrogen sulfide, which is manufactured by the body as an antioxidant and means of transmitting cellular signals that relax blood vessels and increase blood flow. Dr. David W. Kraus, associate professor of environmental science and biology at the University of Alabama and author of a large-scale study on the health benefits of garlic, advises crushing garlic and letting it sit for 15 minutes before cooking it in order to trigger a reaction that boosts the healthy compounds in the plant.

2. Eggs
Experts used to believe egg yolks were extremely unhealthy, they’ve now revised their assertions to recognize the benefits of the nine essential amino acids and six grams of healthy protein contained in one egg. Eggs also contain lutein (helpful in the prevention of macular degeneration), zeaxanthin (similarly good for your eyes and possibly helpful in preventing cataracts), and choline (important in the regulation of the brain, nervous and cardiovascular systems); they’re also one of the only foods that contain naturally occurring Vitamin D. Note that lack of Vitamin D is the cause of many cancers, but especially of breast and prostrate cancer. You should also know that there is no real link between egg consumption and heart disease. The link between Hollandaise sauce and butt flab is well-documented, however, so please ease up on the Benedict.

3. Blueberries
According to a study conducted by Tufts University, the pigments, or anthocyanins, in blueberries appear to be an antidote to oxidative stress, one of the main components of the aging process. They also help your brain produce dopamine, which is critical to happiness, memory and coordination. Tufts researchers found that ½-cup of blueberries daily effectively reversed declining memory and loss of coordination in laboratory rats. Frozen blueberries make a great addition to protein shakes or yogurt, and fresh berries are delicious as an alternative to the sugary candy that will make you fat and probably kill you.

4. Leafy Greens
Spinach and kale – the stuff that made you gag when you were younger but also made Popeye strong enough to fight dudes three times his size – are full of antioxidants and cancer-fighting compounds like sulforaphane, beta carotene, vitamin C, and fiber. Spinach is also loaded with folate, which was shown by an Australian study published by the Journal of Nutrition to dramatically improve short-term memory. Greens are a great thickener for soups and smoothies, but they’re also far more delicious than you remember when sautéed in olive oil, salt and pepper.

5. Broccoli
Another dark-green, antioxidant-rich veggie, broccoli is part of the Cruciferous family of plants that aids the body in fighting against toxins and many forms of cancer. Several nutritional experts believe that eating broccoli raw or steamed helps to preserve important enzymes that are lost in the cooking process, but any broccoli is good broccoli when it comes to its overall health benefits. Broccoli is also a plant source of calcium, which can help prevent osteoporosis later in life and aid in the body’s absorption of Vitamin D.

6. Salmon
You’ve probably heard by now that oily fish like salmon and tuna help to prevent heart disease by keeping arteries lubricated, but salmon is also an excellent source of Omega-3 fatty acids, which, according to omega-3 expert Stephen Cunane, Ph.D., are essential to brain development and health. In fact, Alzheimer’s rates in different countries are consistent with the amount of fish present in the average citizen’s diet. Omega-3’s are also known to aid in weight loss, improve mood and help soothe certain skin conditions. Be mindful of where your fish comes from, though: wild salmon get their adorable pink color from eating krill and shrimp, but farmed salmon are fed food coloring to achieve the same hue. Wild Atlantic Salmon is currently thought to be the safest salmon option.

7. Beets
Doug was right; beets really are nature’s candy. They’re surprisingly sweet, especially considering their low calorie content (approximately 22/beet), and they contain folic acid, one of the most important B vitamins. Preliminary research demonstrates that Betanin, an antioxidant found in the vegetable, could play a significant role in the prevention of heart disease by inhibiting the oxidation of LDL (“bad”) cholesterol. Animal studies also show that eating beets significantly slows the growth of skin and lung cancers, so these babies are poised to become disease-fighting superstars in the not-so-distant future.

8. Flaxseed
Just like salmon, flaxseeds are chock-full of Omega-3 fatty acids (and happen to be one of the few plant sources of that provide the nutrient). Being plants, they also contain several phytoestrogens (as the name suggests, plant estrogen that mimics the healthful effects of estrogen in the body), one of which is lignin, now thought to improve cholesterol, as well as easily absorbed plant protein. Ground flaxseeds and flaxseed oil can be added to everything from oatmeal to pasta dishes in lieu of fattier and more expensive fish.

The research, published in the Nov. 11 issue of the Journal of the American Medical Association, strengthens earlier findings, said study senior author Dr. Henrik Kehlet, a professor of perioperative therapy at Rigshospitalet at Copenhagen University. But this work indicates which women are most likely to experience persistent pain.

“Several previous scientific reports have shown a risk of chronic pain after breast cancer surgery,” said Kehlet. The strength of this study, he noted, is the large number of participants — more than 3,000 — and the evaluation of many types of treatments.
Kehlet’s team reviewed questionnaires filled out by 3,253 women who had undergone breast cancer treatment in Denmark between 2005 and 2006. Their treatments varied and included breast-conserving surgery, mastectomy, radiation, chemotherapy and dissection of the lymph nodes.

The women were asked whether they experienced pain, in what areas of the body, how bad it was and how often they experienced it.
In all, 1,543 — 47 percent — reported pain in one or more areas. Of those, 52 percent reported severe or moderate pain.
Among those who had severe pain, 77 percent said they had it daily. For those who reported their pain as light, 36 percent had it every day. Pain was reported in the breast area, the armpit, the arm and the side of the body.
The research was funded by the Danish Cancer Society, Breast Friends and a private organization that funds science research, the Lundbeck Foundation.
Women under 40 were more than three times more likely to have chronic pain than older women, the researchers found. Those having radiation therapy were more likely to have pain than those who had chemotherapy. Dissection of the axillary (under arm) lymph node was associated with increased likelihood of pain compared to dissection of the sentinel lymph node (the first node to which the cancer is likely to spread).

Why does the pain linger?
“There are multiple mechanisms to explain the risk of chronic pain,” Kehlet said, “such as young age, risk of nerve damage during axillary dissection, radiation therapy or a general pain hyper-responsiveness in some patients.”
More research is needed on the pain mechanism in those who experience high levels of discomfort, he said. The focus for now should be on identifying patients at high risk for pain and providing preventive treatment and nerve-sparing treatment when possible.

The results do not surprise Dr. Robert H. Dworkin, a pain specialist and professor of anesthesiology, neurology, oncology and psychiatry at the University of Rochester School of Medicine and Dentistry in New York, who has also published on lingering cancer pain.
But the findings may come as a surprise to oncologists and others who treat cancer patients, he said. “Women tend not to tell their surgeons about this continuing pain,” he said, citing clinical experience. Why? “They fear that the fact they are in pain might mean a recurrence, and they don’t want to deal with it,” he said. Or, “they don’t want to hurt the oncologist’s feelings.”
A third reason is “they don’t want to distract the physician from thinking about the cancer,” he said.
Even pain specialists can’t say for sure why the pain lingers. “We have little understanding of what causes this kind of pain,” Dworkin said.
A woman in pain after breast cancer treatment “should not be shy in talking to her physician about it,” Dworkin said. He advises such women to ask for a referral to a pain specialist.

One in three of us will be diagnosed with cancer during our life.

The disease tends to affect older people – but can strike at any time.

Excluding certain skin cancers, there were almost 290,000 new cases of the disease in 2005 in the UK.

Some cancer, such as breast, are becoming more common, while new cases of lung cancer are expected to fall away due to the drop in the number of smokers.

However, while the overall number of new cancers is not falling, the good news is that successful treatment rates for many of the most common types are improving rapidly.