Beating Cancer Dream or Future Reality

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Beating Cancer Dream or Future Reality?

• Dr Victor Barley
• Association of Medical Underwriters
• 28 November 2007

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Underwriters Update

• Cancer in perspective
• Recent advances (Surgery, Radiotherapy, Medical
  treatment)
• New approaches (Biological therapy)
• Future developments (Gene therapy)
• Prevention (Vaccination, lifestyle change)
• Risk avoidance

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Cause of death 1911 to 2003
http//www.statistics.gov.uk/CCI/nugget.asp?ID133
7Pos1ColRank1Rank278
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Age-Adjusted Cancer Death Rates, Male and Female,
by Site US, 1930 - 1996
American Cancer Society
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Surgery

• Ideal treatment of cancer
• Cures localized cancer
• including
• spread to lymph nodes
• some spread to liver and lungs
• New techniques reduce impact and widen scope

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Surgery - Examples

• Mastectomy ? Wide excision
• Prostate? Nerve sparing
• Head and neck ? Vascularised graft
• Keyhole surgery - kidney
• Liver and lung resections
• Amputation? Prosthetic replacement

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Radiotherapy

• May eradicate cancer
• Palliates metastases
• Better imaging
• Conformal - higher dose accurately
• Combination with chemotherapy
• Radioactive isotopes

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Chemotherapy

• Cell poison - cures some sensitive cancers and
  leukaemias
• Adjuvant after surgery/radiotherapy
• Scheduled to protect normal cells
• Bone marrow/stem cell transplant
• Palliation of recurrence and distant metastases
• Better drugs and schedules

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Breast Cancer - Survival
http//info.cancerresearchuk.org/cancerstats/survi
val/fiveyear/
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Breast Cancer Mortality Trend
http//info.cancerresearchuk.org/cancerstats/types
/breast/mortality/
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Hormone Therapy

• Slows growth of some tumours with hormone
  receptors (breast, prostate)
• Steroids reduce swelling/inflammation
• Improved general wellbeing
• Fewer side effects than chemotherapy
• Adjuvant breast? better survival
• Palliative? better quality of life
• Control rather than cure

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Prostate Cancer - Survival
http//info.cancerresearchuk.org/cancerstats/survi
val/fiveyear/
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Immunotherapy

• Reduced immunity permits cancer?
• Natural immunity ?cancer avoided?
• Spontaneous cure (melanoma, kidney)
• Boost immune response?
• Specific antibodies?
• Targeted drugs or radioisotopes
• Vaccine for metastatic cancer (melanoma)

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Biological

• Cell signaling influence adjacent cells growth
• Use natural growth control (VEGF)
• Correct loss of suppression (p53)
• Slow down or arrest growth (kinase inhibitors)
• Fewer side effects than chemotherapy
• Add to established treatment

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Genes

• Inherited tendency (BRCA, FAP)
• Susceptibility to carcinogens
• Poor tolerance of treatment (AT)
• Prevention (bilateral mastectomy, colectomy)
• Gene manipulation?

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Early Detection/prevention Individual/GP

• Screening (mammography, PSA, ß-HCG and
  a-foetoprotein)
• Education (aware of signs of cancer)
• Lifestyle (benefit in 30 40 years)
• Vaccination (if agent known)
• Constant monitoring?

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Testicular Cancer Mortality Trend
http//info.cancerresearchuk.org/cancerstats/types
/testis/mortality/
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Early Diagnosis - Education

• Lumps (1 in 10 breast lumps malignant)
• Bleeding (urine, bowel)
• Unhealing ulcers
• Screening (cervix, breast, prostate)
• Pre-malignant ablate/monitor
• Self Aware individual responsibility

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Vaccination Potential

• Human papilloma virus (cervix, skin)
• Epstein-Barr virus (nasopharynx, Burkitts
  lymphoma, Hodgkins Disease)
• Herpes simplex (Kaposis sarcoma)
• Hepatitis C (leukaemia, liver)
• HIV (Kaposis sarcoma, lymphoma)
• HTLV-1 (leukaemia / lymphoma)

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http//info.cancerresearchuk.org/cancerstats/morta
lity/?a5441
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Lifestyle

• Smoking
• Alcohol
• Obesity
• Diet
• Sun
• Environment
• Work/life balance

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Thank You!

• Dr Victor Barley