Cancer: A global threat
The World Health Organization is warning of a global “tidal wave” of cancer and says that by 2035, around 24 million people will have the disease.
Why is cancer such a threat?
Globally, one in five men and one in six women will develop cancer before the age of 75.
And one in eight men, and one in twelve women, will die from the disease.
Cancer is the leading cause of economic loss through premature death and disability worldwide - because of the vast sums spent on treatment, but also in lost economic and social activity.
In 2010, WHO says the total annual economic cost of cancer was $1.16 trillion (£700bn).
Cancer costs countries in the European Union 126bn euro (£107bn) a year, according to the first EU-wide analysis of the economic impact of the disease.
The charity Cancer Research UK said it was a “huge burden”.
The figures, published in the Lancet Oncology, included the cost of drugs and health care as well as earnings lost through sickness or families providing care.
Lung cancer was the most costly form of the disease.
The team from the University of Oxford and King’s College London analysed data from each of the 27 nations in the EU in 2009.
The showed the total cost was 126bn euro and of that 51bn (£43bn) euro was down to healthcare costs including doctors’ time and drug costs.
Lost productivity, because of work missed through sickness or dying young, cost 52bn (£44bn) euro while the cost to families of providing care was put at 23bn (£19.5bn) euro.
Overall, richer countries, such as Germany and Luxembourg, spent more on cancer treatment per person than eastern European countries such as Bulgaria and Lithuania.
Lung cancer accounted for more than a tenth of all cancer costs in Europe. The deadly cancer tends to affect people at an earlier age than other cancers so the lost productivity through early deaths is a major factor.
Other issues
However, the overall economic burden is behind the costs of dementia and cardiovascular disease.
An EU-wide study, by the same research group, showed cardiovascular diseases, including high blood pressure and stroke, cost 169bn euro (£144bn) a year while dementia cost 189bn euro (£169bn) in just 15 countries in Western Europe.
Dementia has very high costs associated with long-term care while cardiovascular diseases include such a wide range of conditions it affects many more people than cancer.
One of the researchers, Dr Ramon Luengo-Fernandez, from the Health Economics Research Centre at the University of Oxford, said: “By estimating the economic burden of several diseases it will be possible to help allocate public research funding towards the diseases with the highest burden and highest expected returns for that investment.”
Prof Richard Sullivan, from King’s College London, said: “It is vital that decision-makers across Europe use this information to identify and prioritise key areas.
“More effective targeting of investment may prevent health care systems from reaching breaking point - a real danger given the increasing burden of cancer - and in some countries better allocation of funding could even improve survival rates.”
Sara Osborne, head of policy at Cancer Research UK, said: “The financial impact that cancer has on the economy across Europe due to people dying prematurely from the disease and time off work remains a huge burden.
“This study reinforces why research is vital to improve our understanding of the causes of cancer - so that we lessen the impact of the disease and develop better ways to prevent and treat the illness.
“We also need to understand why the UK’s cancer mortality rates remain higher than many EU countries despite a similar spend on cancer care.”
Why is it still spreading?
Despite treatment advances and screening programmes to detect the disease earlier, the cancer burden will increase.
The world’s population is growing and lifespan is increasing. This means there will be more and more people who can develop cancer.
Currently, 14 million people a year are diagnosed with cancer. WHO says that will increase to 19 million by 2025, 22 million by 2030 and 24 million by 2035.
Why is cancer so common?
What is cancer?
Cancer starts when cells in our bodies start to reproduce out of control, forming new, abnormal cells. These abnormal cells form lumps, known as tumours.
If the cells from tumours cannot spread, then the tumours are benign. They are not cancerous and can usually be removed.
If the cells are able to invade nearby healthy tissue and organs, or spread around the body through the blood or lymphatic system causing further tumours to grow, then the tumours are malignant or cancerous. These cancer cells are likely to spread if the tumour is not treated.
What causes cancer?
Every cell in our body contains DNA. It carries our genetic code and contains the instructions for all the cell’s actions.
If the DNA inside cells is damaged, these instructions go wrong. In fact damage to the DNA or “mutations” as they are known, constantly occur in our cells as they divide and reproduce. Most of the time, the cells recognise that a mutation has occurred and repair the DNA, or self-destruct and die.
When a number of mutations have occurred in the DNA of a cell, control of cell growth may be lost and the cells do not die. Instead they start to follow abnormal instructions that make them reproduce and grow, producing more and more of these mutated cells - this is the start of a cancer.
Many factors such as smoking or too much exposure to the sun can also trigger DNA damage - leading to a faster accumulation of the mutations which lead to cancer.
A family history of cancer can also increase chances of getting the disease, because it usually means that person starts their life already having inherited some of the DNA mutations that take them down the path to cancer.
Even when in remission, those who have had the disease have a higher risk of it developing again. In most cases however, the exact cause or sequence of events by which cancer develops, is not yet known
A recent study has found that there are more than 80 genetic markers (i.e. mutated genes) that can increase the risk of developing breast, prostate or ovarian cancer, for example. Scientists believe the results could soon lead to widespread use of DNA profiling for these cancers, though individual genetic testing for those likely to be at increased risk - such as when there is a strong family history of a type of cancer - is already in use.
Why is it so deadly?
Cancer cells are able to invade other parts of the body, where they settle and grow to form new tumours known as secondary deposits - the original site is known as the primary tumour. The cells spread by getting into the blood or lymph vessels and travelling around the body.
For example, if bowel cancer has spread through the wall of the bowel itself, it can start growing on the bladder. If cells enter the bloodstream they can travel to distant organs, such as the lungs or brain. Over time, the tumours will then replace normal tissue.
The process of cancer cells spreading is called metastasis. Once a cancer has started to spread, the chances of a cure often begin to fall, as it becomes more difficult to treat for a variety of reasons.
Cancer harms the body in a number of ways. The size of the tumour can interfere with nearby organs or ducts that carry important chemicals. For example, a tumour on the pancreas can grow to block the bile duct, leading to the patient developing obstructive jaundice. A brain tumour can push on important parts of the brain, causing blackouts, fits and other serious health problems. There may also be more widespread problems such as loss of appetite and increased energy use with loss of weight, or changes in the body’s clotting system leading to deep vein thrombosis.
Why is it so hard to stop?
Cancer is an extremely complex condition. Each type of cancer is biologically different from any other type. For example, skin cancer is biologically different from the blood cancer called lymphoma, of which there are then many different types.
That is then coupled with genetic differences between individuals and the often random nature of the DNA mutations that cause cancer.
All this makes it difficult to identify the way the particular cancer cells are behaving and how they are likely to spread or damage the body. Without a full understanding of the physiology of the cancer, effective treatments are hard to develop.
Early surgery to remove tumours can work. But the cancer can return if any cells are left behind. It can also return if cells have broken away from the primary tumour and formed microscopic secondary tumours elsewhere in the body before an operation to remove the primary.
And because cancer cells are our own body’s cells, many treatments to destroy them also risk destroying our healthy cells.
One controversial theory of why cancer is so hard to stop is that it is rooted in the ancient traits of our genes.
Prof Paul Davies from Arizona State University believes cancer may use tried-and-tested genetic pathways going back a billion years to the dawn of multicellular life, when unregulated cell growth would have been an advantage.
He argues that this tendency was suppressed by later, more sophisticated genes, but lies dormant in all living organisms. Cancer occurs when something unlocks these ancient pathways.
Other scientists disagree, saying that these pathways would not have survived millions of years of evolution.
One thing is for sure - our genes hold the key to understanding cancer and how to treat it.
The future of cancer research
The field of cancer research is moving away from defining a cancer by where it is in the body, as one type of breast cancer can have more in common with an ovarian cancer than another cancer in the breast.
Instead scientists are looking deeper at what is going wrong inside cancerous cells - a tumour can have 100,000 genetic mutations and these alter over time.
By pinpointing the mutations that can cause certain cancers, doctors hope to personalise treatment - choosing the drug most likely to work on a particular type of tumour.
Scientists are creating targeted cancer therapies using their latest insights into cancer at a molecular level. These treatments block the growth of cancer by interfering with genetic switches and molecules specifically involved in tumour growth and progression.
Clinical trials using gene therapy are also underway. This experimental treatment involves adding genetic material into a person’s cells to fight or prevent disease.
Why is cancer such a threat?
Globally, one in five men and one in six women will develop cancer before the age of 75.
And one in eight men, and one in twelve women, will die from the disease.
Cancer is the leading cause of economic loss through premature death and disability worldwide - because of the vast sums spent on treatment, but also in lost economic and social activity.
In 2010, WHO says the total annual economic cost of cancer was $1.16 trillion (£700bn).
Cancer costs countries in the European Union 126bn euro (£107bn) a year, according to the first EU-wide analysis of the economic impact of the disease.
The charity Cancer Research UK said it was a “huge burden”.
The figures, published in the Lancet Oncology, included the cost of drugs and health care as well as earnings lost through sickness or families providing care.
Lung cancer was the most costly form of the disease.
The team from the University of Oxford and King’s College London analysed data from each of the 27 nations in the EU in 2009.
The showed the total cost was 126bn euro and of that 51bn (£43bn) euro was down to healthcare costs including doctors’ time and drug costs.
Lost productivity, because of work missed through sickness or dying young, cost 52bn (£44bn) euro while the cost to families of providing care was put at 23bn (£19.5bn) euro.
Overall, richer countries, such as Germany and Luxembourg, spent more on cancer treatment per person than eastern European countries such as Bulgaria and Lithuania.
Lung cancer accounted for more than a tenth of all cancer costs in Europe. The deadly cancer tends to affect people at an earlier age than other cancers so the lost productivity through early deaths is a major factor.
Other issues
However, the overall economic burden is behind the costs of dementia and cardiovascular disease.
An EU-wide study, by the same research group, showed cardiovascular diseases, including high blood pressure and stroke, cost 169bn euro (£144bn) a year while dementia cost 189bn euro (£169bn) in just 15 countries in Western Europe.
Dementia has very high costs associated with long-term care while cardiovascular diseases include such a wide range of conditions it affects many more people than cancer.
One of the researchers, Dr Ramon Luengo-Fernandez, from the Health Economics Research Centre at the University of Oxford, said: “By estimating the economic burden of several diseases it will be possible to help allocate public research funding towards the diseases with the highest burden and highest expected returns for that investment.”
Prof Richard Sullivan, from King’s College London, said: “It is vital that decision-makers across Europe use this information to identify and prioritise key areas.
“More effective targeting of investment may prevent health care systems from reaching breaking point - a real danger given the increasing burden of cancer - and in some countries better allocation of funding could even improve survival rates.”
Sara Osborne, head of policy at Cancer Research UK, said: “The financial impact that cancer has on the economy across Europe due to people dying prematurely from the disease and time off work remains a huge burden.
“This study reinforces why research is vital to improve our understanding of the causes of cancer - so that we lessen the impact of the disease and develop better ways to prevent and treat the illness.
“We also need to understand why the UK’s cancer mortality rates remain higher than many EU countries despite a similar spend on cancer care.”
Why is it still spreading?
Despite treatment advances and screening programmes to detect the disease earlier, the cancer burden will increase.
The world’s population is growing and lifespan is increasing. This means there will be more and more people who can develop cancer.
Currently, 14 million people a year are diagnosed with cancer. WHO says that will increase to 19 million by 2025, 22 million by 2030 and 24 million by 2035.
Why is cancer so common?
What is cancer?
Cancer starts when cells in our bodies start to reproduce out of control, forming new, abnormal cells. These abnormal cells form lumps, known as tumours.
If the cells from tumours cannot spread, then the tumours are benign. They are not cancerous and can usually be removed.
If the cells are able to invade nearby healthy tissue and organs, or spread around the body through the blood or lymphatic system causing further tumours to grow, then the tumours are malignant or cancerous. These cancer cells are likely to spread if the tumour is not treated.
What causes cancer?
Every cell in our body contains DNA. It carries our genetic code and contains the instructions for all the cell’s actions.
If the DNA inside cells is damaged, these instructions go wrong. In fact damage to the DNA or “mutations” as they are known, constantly occur in our cells as they divide and reproduce. Most of the time, the cells recognise that a mutation has occurred and repair the DNA, or self-destruct and die.
When a number of mutations have occurred in the DNA of a cell, control of cell growth may be lost and the cells do not die. Instead they start to follow abnormal instructions that make them reproduce and grow, producing more and more of these mutated cells - this is the start of a cancer.
Many factors such as smoking or too much exposure to the sun can also trigger DNA damage - leading to a faster accumulation of the mutations which lead to cancer.
A family history of cancer can also increase chances of getting the disease, because it usually means that person starts their life already having inherited some of the DNA mutations that take them down the path to cancer.
Even when in remission, those who have had the disease have a higher risk of it developing again. In most cases however, the exact cause or sequence of events by which cancer develops, is not yet known
A recent study has found that there are more than 80 genetic markers (i.e. mutated genes) that can increase the risk of developing breast, prostate or ovarian cancer, for example. Scientists believe the results could soon lead to widespread use of DNA profiling for these cancers, though individual genetic testing for those likely to be at increased risk - such as when there is a strong family history of a type of cancer - is already in use.
Why is it so deadly?
Cancer cells are able to invade other parts of the body, where they settle and grow to form new tumours known as secondary deposits - the original site is known as the primary tumour. The cells spread by getting into the blood or lymph vessels and travelling around the body.
For example, if bowel cancer has spread through the wall of the bowel itself, it can start growing on the bladder. If cells enter the bloodstream they can travel to distant organs, such as the lungs or brain. Over time, the tumours will then replace normal tissue.
The process of cancer cells spreading is called metastasis. Once a cancer has started to spread, the chances of a cure often begin to fall, as it becomes more difficult to treat for a variety of reasons.
Cancer harms the body in a number of ways. The size of the tumour can interfere with nearby organs or ducts that carry important chemicals. For example, a tumour on the pancreas can grow to block the bile duct, leading to the patient developing obstructive jaundice. A brain tumour can push on important parts of the brain, causing blackouts, fits and other serious health problems. There may also be more widespread problems such as loss of appetite and increased energy use with loss of weight, or changes in the body’s clotting system leading to deep vein thrombosis.
Why is it so hard to stop?
Cancer is an extremely complex condition. Each type of cancer is biologically different from any other type. For example, skin cancer is biologically different from the blood cancer called lymphoma, of which there are then many different types.
That is then coupled with genetic differences between individuals and the often random nature of the DNA mutations that cause cancer.
All this makes it difficult to identify the way the particular cancer cells are behaving and how they are likely to spread or damage the body. Without a full understanding of the physiology of the cancer, effective treatments are hard to develop.
Early surgery to remove tumours can work. But the cancer can return if any cells are left behind. It can also return if cells have broken away from the primary tumour and formed microscopic secondary tumours elsewhere in the body before an operation to remove the primary.
And because cancer cells are our own body’s cells, many treatments to destroy them also risk destroying our healthy cells.
One controversial theory of why cancer is so hard to stop is that it is rooted in the ancient traits of our genes.
Prof Paul Davies from Arizona State University believes cancer may use tried-and-tested genetic pathways going back a billion years to the dawn of multicellular life, when unregulated cell growth would have been an advantage.
He argues that this tendency was suppressed by later, more sophisticated genes, but lies dormant in all living organisms. Cancer occurs when something unlocks these ancient pathways.
Other scientists disagree, saying that these pathways would not have survived millions of years of evolution.
One thing is for sure - our genes hold the key to understanding cancer and how to treat it.
The future of cancer research
The field of cancer research is moving away from defining a cancer by where it is in the body, as one type of breast cancer can have more in common with an ovarian cancer than another cancer in the breast.
Instead scientists are looking deeper at what is going wrong inside cancerous cells - a tumour can have 100,000 genetic mutations and these alter over time.
By pinpointing the mutations that can cause certain cancers, doctors hope to personalise treatment - choosing the drug most likely to work on a particular type of tumour.
Scientists are creating targeted cancer therapies using their latest insights into cancer at a molecular level. These treatments block the growth of cancer by interfering with genetic switches and molecules specifically involved in tumour growth and progression.
Clinical trials using gene therapy are also underway. This experimental treatment involves adding genetic material into a person’s cells to fight or prevent disease.
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