COMMENTARY

Cancer News to 'Shout From the Rooftops'

David J. Kerr, CBE, MD, DSc

Disclosures

March 16, 2021

This transcript has been edited for clarity.

I'm David Kerr, professor of cancer medicine at the University of Oxford. I'd like to discuss a paper published recently in Annals of Oncology by some pals of mine, Carlo La Vecchia, Paolo Boffetta, and their colleagues — a fantastic bunch of Italian epidemiologists predominantly from the Milan region. They've done some wonderful work over decades to project cancer death rates across the European Union. This report makes interesting reading.

They used large databases, which they helped to establish, along with a clever regression model — something called joinpoint regression — to estimate cancer death rates for 2021 across the most populous countries of Europe. They then compared those estimates with death rates in 2015 and also earlier, with the help of their extraordinary longitudinal database.

This is a useful tool because it allows policymakers and clinicians to understand where the major cancer health problems exist, thus enabling them to divert the necessary resources to the right tumors and the right stage in the cancer journey, in terms of cancer control. This provides an extremely useful piece of data that has been well worked out by a highly respected group.

They showed that there are significant reductions across the board in many of the common solid tumor types. We're gaining ground with breast, stomach, colon, and lung cancer (in men). There's still an upward trend of lung cancer incidence and deaths in women.

The one resolutely difficult cancer is pancreatic cancer. We have seen significant reductions in the majority of the common solid tumor types, but we don't see this with pancreatic cancer at all. In terms of the epidemiology of pancreatic cancer, about 20% of pancreatic cancer cases are caused by smoking. Thus, tobacco control is a very important element of the European Union's approach to cancer control, and correctly so.

But although we've seen big improvements in male lung cancer incidence because of major improvements in tobacco control, we don't see this even remotely to the same extent with pancreatic cancer. Perhaps in younger patients, those under 50 years old, we're beginning to see some early signs that the tobacco control regime is starting to make a difference. Other contributory factors to pancreatic cancer — diet, diabetes, and so on — don't seem to have changed much. It is disappointing that the death rate for pancreatic cancer remains pretty flat.

We know that this is a desperate illness when it presents at an advanced stage with metastasis. In that case, life is significantly abbreviated. We just don't have enough tools in our therapeutic toolbox to deal with it. That is probably the overriding factor.

We can glean a number of insights from this large-scale study. For example, between 1988 and 2021, we have seen 5 million fewer deaths because of the improvements in prevention, early diagnosis, and treatment. Isn't that fantastic? Over that prolonged period of time, 5 million deaths have been avoided because of the steps we've taken to improve every element of the cancer control journey.

Pancreatic cancer sticks out like a sore thumb, so we need better, more thoughtful health policy aimed at pancreatic cancer — better understanding of prevention, better understanding of its biology, and improved means of early detection that are cost-effective.

One thing that made me smile a little is that my very good friends in this fantastic Italian group talk about the EU 27 and the United Kingdom separately. So, because of Brexit, this is something I'm going to have to get used to — that the UK figures, which broadly parallel the rest of the European Union, are reported separately.

We are an island unto ourselves, as John Donne might have said, and I guess we're going to have to get used to being rather distinct and rather separate than we have done for the past several decades.

This is a very interesting comparative study that includes very compelling data telling us that we need a laser-sharp focus on what we're going to do about pancreatic cancer globally.

Thanks very much for listening. Progress made: 5 million cancer deaths avoided between 1988 and now. It's something to rejoice about and shout from the rooftops. But we hope more progress is yet to be made. Thanks for listening. I welcome any comments that you may care to make. For the time being, Medscapers, ahoy.

David J. Kerr, CBE, MD, DSc, is a professor of cancer medicine at the University of Oxford. He is recognized internationally for his work in the research and treatment of colorectal cancer and has founded three university spin-out companies: COBRA Therapeutics, Celleron Therapeutics, and Oxford Cancer Biomarkers. In 2002, he was appointed Commander of the British Empire by Queen Elizabeth II.

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