Today was the first full day of this year's NCRI Cancer Conference. With memories still fresh of last night's debate, the positive feedback from those who attended and the discussion still trending on the conference twitter feed, it’s safe to say that expectations were pretty high, blogs Breakthrough Breast Cancer's Dr Matthew Lam.
Dark ages to Enlightenment
Our day kicked off with a set of lectures by some people with pretty impressive CVs. Sir Mike Richards - Chief Inspector of Hospitals at the Care Quality Commission - was up first to give a past, present and future perspective on UK cancer services. Mike described the 1980s as the “dark ages of cancer”, explaining that there was very little discussion about cancer in general, like it was a taboo. At the time, because the UK had a world leading health service, it was assumed that the UK must be doing as good as the rest of the world and if the data suggested otherwise (which it did), it must be wrong. As a result, cancer was never on the political agenda, although still clearly a health burden at the time.
In the late 1980s it became slightly more evident that cancer was moving into the mainstream - the UK had “woken up late to the problem”. Mike cites the introduction of breast screening as a pivotal movement for politics and the public to engage in cancer. In the 1990s and early 2000s real change was achieved in cancer services by patient and charity voices becoming louder and louder. This in turn pushed cancer onto the agenda of politics and the media - leading to cancer becoming the top health priority it still is today.
Improvements to the cancer service were to follow. Commitments were made on national waiting times, cancer networks of patients, doctors and nurses were formed and multi-disciplinary teams took over care of patients in the clinic. These are all policy issues Breakthrough have been behind from day one - working hard to embed real change into the care of breast cancer patients across the UK.
Show me the money
The next talk was given by Sir Mike Stratton - the world famous geneticist - who spoke about the advances in whole genome sequencing. He explained that the technology has advanced so rapidly that we have been able to delve deeper than ever before into the genetic basis of cancer. He argued that tumour DNA analysis needs to be on the agenda for funders of research as it has the power to provide a wealth of information spanning cancer prevention, diagnosis and treatment.
Later in the day we heard from experts in the world of circulating tumour DNA - the DNA expelled from dying cancer cells into the blood stream of patients. Our scientist Dr Nick Turner is heavily involved in research in this area so it was exciting to hear what others in the field are up to. We were told that the advances in the detection and analysis of circulating tumour DNA meant that the use of this technology in the clinic was just around the corner.
One speaker predicted that in just one year, the analysis of this DNA with a blood test could be used routinely to not only diagnose patients but also to monitor how well they are responding to treatment. Another speaker went on to say they believed that within five years blood tests will be used to diagnose all cancer patients and to predict who is likely to develop resistance to the treatment they are on or relapse later in life.
Prevention - the day’s hot topic
A session on cancer prevention was attended by so many people, some were made to stand, all seats filled with those keen to hear to talks. This shows just how important the research community believes prevention is to cancer and why we have identified it as one of the key priorities in our strategy to stop breast cancer for good.
Jack Cuzick spoke specifically about breast cancer, saying that different approaches to prevention need to be given to different groups of women. Not all women benefit from the same intervention in the same way, so it’s important that they are given advice based on their individual risk and their prevention plan is designed to match it. This is great to hear as our huge prevention study - the Generations Study - is aiming to achieve just that.
The other big discussion around prevention was the topic of obesity. Speaker Tim Lobstein stated that obesity, as a risk factor for cancer, had already overtaken other well known risk factors such as smoking - “we’re up against it as the food industry benefits from obesity - or rather from people eating - and it’s an industry which is well financed and hugely influential.”
The Cancer Drugs Fund - is it a benefit?
An initial vote showed the audience was split on the issue, and a lively few rounds of argument and question ensued to explore the issue fully. Some of the arguments in favour included the fact that the CDF does mean that some cancer patients, especially those with rarer cancers, can access drugs they otherwise wouldn't have had. The speakers suggested the CDF is also clear, transparent and easy for people to understand, and that it has shown what is possible when there is the political will to make changes.We finished off the day with our second debate of the conference. This time about the Cancer Drugs Fund, or CDF, debating whether this has been a good thing for British cancer patients - a seemingly difficult position to defend when the fund only provides important cancer drugs to patients in England and not the devolved nations.
But the arguments against were hard to counter. In an NHS system set up to provide fair and equal provision of care, the CDF doesn't stand up. It was perhaps summed up best by a patient from Northern Ireland who pointed out an inequality from his own personal experience. He had been on a trial of a new treatment for prostate cancer. A trial that took place in Northern Ireland, a trial of a drug that was successful - a drug that is now only available to patients in England through the CDF.
Other points raised, interestingly from both sides of the debate, suggested that the CDF undermines the work of NICE, and removes the incentive for big pharmaceutical firms to lower their prices for cancer drugs. One speaker suggested that perhaps those who have really benefitted most from the CDF are the pharmaceutical companies, not patients.
In the end the crowd voted overwhelmingly against - the CDF had not been a good thing for British cancer patients. A huge swing from the initial split decision. Both sides of the debate were swift to highlight that the CDF is by no means perfect. And that it needs to change to be both sustainable and fairer. Tom Crosby's final comment reverberated around the room: "It is impossible to put a price on a life, but it is possible to put a fair price on drugs." And we couldn't agree more. We want patients to be able to access the drugs that they need. If you feel the same, let your voice be heard and join our campaign to Demand a Fair Price for life-extending drugs.
Join the conference debate on Twitter at #NCRIbcdeb.
Dr Matthew Lam is Breakthrough Breast Cancer’s Senior Research Officer.