An increasing survival rate is wonderful news. But if drug costs soar, the benefit of future research will by stymied

Half of all cancer patients now survive 10 years, twice the proportion of 40 years ago

 

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A generation ago people were so terrified of cancer that many dared not mention it. Even to use the word spelt doom. Today, a cancer diagnosis still strikes terror. But slowly we are learning that it need not be a death sentence – that we can, after all, live with it.

That half of all cancer patients now survive 10 years, twice the proportion of 40 years ago as reported by Cancer Research UK, is a significant sign of success. It is important too because while the death rate is dropping, the incidence rate is soaring. Four out of every 10 people living today will develop cancer at some point.

The key to curing the disease is to catch it early, before it has spread outside the breast, bowel, prostate gland or other organ where it is located. For solid tumours, surgery is needed to remove the cancerous tissue before remaining cancer cells are mopped up with drugs and radiation. It is here that there has been real progress over the past 40 years, with big improvements in survival rates. Earlier detection followed by skilful surgery has cured more cancer than chemotherapy and radiotherapy combined.

For most patients earlier detection helps, but not for all. In some, it means they are diagnosed and treated sooner, only to die at the same point that they would have done had their cancer been detected later. They thus live longer with the knowledge of their cancer (and the anxiety that can cause), contribute to the improving survival statistics, but gain no survival benefit. This is the kernel of the ongoing dispute over breast screening.

It is when cancer has spread that it becomes harder to treat – outside the “primary” organ such as the breast or prostate gland to the bones, brain, lungs or liver. It is relatively easy to spot a lesion on the skin or a lump in the breast – harder to spot one in the pancreas or the lung because symptoms such as stomach ache or cough tend to be attributed to other, less serious causes. In these cancers, and those of the oesophagus and brain, survival rates remain low and progress in recent decades has been disappointing.

When cancers have spread, it is too late for surgery or radiotherapy, and the only treatment is drugs. Developing effective cancer drugs depends on understanding the mechanisms of the disease at the cellular level. Yet despite decades of research and the expenditure of billions of pounds, successes are limited.

Cancer is not a single disease. There are at least 200 different types of it, and what are today regarded as single cancers, such as breast cancer, may in future be understood as collections of different forms, each treatable with different drugs.

Last week Kadcyla, a new breast cancer drug, was turned down by the National Institute for Health and Care Excellence (Nice) because the benefit it offered to patients was judged too small to justify its £90,000 per head price tag to the NHS.

In the future, as each drug will have a smaller potential patient population, the costs are bound to rise. Cancer Research UK wants to see the overall survival rate from the disease grow from half to three-quarters by 2030. It is a commendable ambition. But the charity needs to set a second goal – finding a way to help the NHS afford the treatments it develops.

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