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You and Yours - Transcript 成人论坛 Radio 4 |
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TX: 30.08.07 - Lung Cancer PRESENTER: WINIFRED ROBINSON |
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THE ATTACHED TRANSCRIPT WAS TYPED FROM A RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT. BECAUSE OF THE RISK OF MISHEARING AND THE DIFFICULTY IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE 成人论坛 CANNOT VOUCH FOR ITS COMPLETE ACCURACY. ROBINSON Lung Cancer is in the news because of the gruesome pictures that are artily displayed on cigarette packets by government order. The images show tumours, diseased organs and patients - faces covered in oxygen masks in the final stages of the disease. Lung cancer claims more lives in the UK than any other cancer - more women die of lung cancer than breast cancer but you'd never guess that from the media coverage or more importantly from the funding it receives. Just to give you a few figures: 38,000 new cases of lung cancer are diagnosed in the UK each year; someone dies of lung cancer every 15 minutes and yet it attracts only 4% of the national cancer research funds. Michael Seckl is a lung cancer specialist, he's professor of molecular cancer medicine at Imperial College London. Professor, why is lung cancer then so deadly even compared with other cancers? SECKL Well unfortunately it tends to present quite late when the disease has frequently spread to other parts of the body, so that surgical cure is no longer possible. And it also tends to be quite resistant to the existing drugs that we have and radiation therapy that we have to treat it. So that even if patients display an initial response to those treatments the disease comes back and when it comes back it's usually completely resistant to further therapy. So it really is a devastating illness for patients to contract. ROBINSON You mention screening but is there any evidence that if we screen for early lung cancer and then we moved in and started operating on people that we would stop the cancer spreading? SECKL I think that we need to develop better screening strategies than the ones that we currently have available. So originally we attempted to do chest x-ray screening strategies and these didn't really show any benefit at all.... ROBINSON Because you can't see the tumours until they're big? SECKL That's right. So CT scanning has enabled a greater degree of ability to see smaller tumours. But the problem is one has quite a high false positive rate and what that means is that patients end up having unnecessary operations for things that weren't cancer in the first place. So there is a need to try and develop additional tests that could diagnose lung cancer as being present and then use CT screening to then identify where the tumours are for early resection. And then we need to obviously conduct trials to see whether that effectively reduces the rate of lung cancers. Those of us that work in the field firmly believe that it will make a difference but clearly we need to do trials to prove that. ROBINSON What about the survival rates for people who have the cancer now? SECKL They really are fairly appalling, about 10% alive at three years and less than 5% at five years. ROBINSON And five years - is that what we set as having survived a cancer when you look at the government statistics? SECKL Generally speaking yes, that's what one would like to see. Yep. ROBINSON Well there are of course a minority at 5%, as you've just said, who do respond well to treatment and who are living with lung cancer and we went to the Robert Ogden Macmillan Centre at St James's Hospital in Leeds where we met one such patient and his nurse. HALL I'm Kenny Hall and I'm 55 years old, ex-lorry driver. I was diagnosed in August 2004. Myself and my wife went to the Leeds Chest Clinic where I'd had an x-ray and I was told to come back because they'd found something wrong with the x-ray and I went back and I was told that I had a tumour on my right lung. We just - we couldn't believe when we was told, we came out the clinic and we was outside and the chest clinic's in the middle of Leeds and we stood outside and I just looked at my wife, she burst into tears, I burst into tears and she says to me - What am I going to do now? - and I said - We're going to fight it, that's what we're going to do, we'll do the best we can. WHITE My name's John White and I lead a team of Macmillan lung cancer nurse specialists within the Leeds Trust. We know from experience the majority of people unfortunately have smoked which is one of the main predisposing factors to lung cancer but not the only one, there are other factors as well. We do deal with other lung cancers, also called mesothelioma, which is asbestos related disease. But certainly smoking is probably the main predisposing factor. HALL Yes I know I smoked but there's people that drink, there's people that take drugs, you know, what do they do to them? They don't persecute them, why do they persecute the smoker you know. If I've had the advice what's here now and seen what I've seen now I definitely wouldn't have smoked, I know that. WHITE Yes there is a perception that it is a self inflicted disease, that there is a stigma but people also have to realise that many, many years ago people were encouraged to smoke and the dangers weren't known then. HALL It amazes me the amount of money that's pumped into breast cancer, into the research and that, but with lung cancer the stigma's there because people have smoked, they think because it's a smoking related disease, which it is, it doesn't help, I do appreciate that, but there's people - there's half the people in my group - in my support group - that come there that have never smoked in their life. I've just heard of this last week of a young girl of 23 year old contracting lung cancer, never smoked in her life, you know you can't expect her to have that stigma, to be cut short. You know I didn't expect to be not working at this time of my life. We was at a stage where I was working for my retirement, now I am retired unfortunately. I can't run for a bus now like I used to do, but to look at me you'd think well he won't have that problem you know but I do have this problem and I have to have drugs, I have to take tablets and that to help keep me going. But it's all part of the life that I have to get used to now. WHITE In no one person is the disease the same. We have techniques now that are better at detecting disease and therefore things like PET scanners, we are operating perhaps on the - better on the right patients and we are perhaps targeting the treatment [indistinct word] to the right patients. So we hope Ken's cured. HALL I've not beaten it yet. You think it's going to return and every little ache that you get and little pain that you get but I have to keep going for my wife. She's been there at the side of me. I feel sorry for her because she's going through it as well with me. Life has to go on and I make the most of it. ROBINSON Kenny Hall in Leeds. Well the image of lung cancer was lifted in the early 1990s when the entertainer Roy Castle announced that he had the disease. He was a non-smoker but he had spent much of his working life in smoky clubs and pubs. The Roy Castle Lung Cancer Foundation now supports patients and research, it's based in Liverpool and in Glasgow - two cities with a high incidence of the disease. Joyce Dunlop is their director of patient care. What percentage then of lung cancer patients have never smoked? DUNLOP The figure ranges from about 8-10%. ROBINSON So it is then a largely self inflicted cancer, so why do you think it's considered more shameful than lots of other diseases that we all inflict on ourselves - heart disease I suppose is the best example? DUNLOP Frankly I don't quite know why it's got such a stigma because it causes just as many heart problems as it does in relation to lung cancer. ROBINSON And many of the people you see I guess would have given up long ago? DUNLOP They have and lung cancer is rarely diagnosed in people who are under 40 but thereafter it peaks in people around kind of 70-79 and they were starting smoking when actually in some cases it was their local doctor who was suggesting they take up smoking because it would relieve their stress... ROBINSON Really? DUNLOP So for the stigma to be affecting people who are undergoing treatment just now well they started their smoking habit when there was just not the awareness that there is now. ROBINSON I want to bring Ian Gibson into the discussion, he's the Labour MP for Norwich North and he also chairs the All Party Parliamentary Group on Cancer. Do you think that this lack of public sympathy is the reason why lung cancer attracts so little funding? GIBSON Yes I think that and the information that's out there that suggests that there's not much you can do about it, there's a sort of terminability about the whole thing. Well of course that is wrong, that should not be our attitude, we need much more political determination as we've shown with some of the other cancers as some of the other speakers have said. And lung cancer, I think, has suffered greatly in terms of the new cancer plan, it's been with us for five years or so now. ROBINSON Does this business of being able to effectively lobby politicians play any part in the way cancer research funds are doled out? GIBSON Oh yes and since we started the [indistinct words] Mike Richards and I and a few others started really pressurising in 1998, we've seen a new cancer plan, we've seen the National Cancer Research Institute, we've seen major cancer charities merging together and in terms of lobbying ministers, lobbying governments, that's more powerful than each individual one and we're seeing more and more of that happening, it's now a family that we have in cancer and all the patient groups are working together to really put the pressure on to the extent that we're now in the middle of some would say cancer plan 2 but the government would call it a reform strategy. And hopefully lung cancer is going to feature as prominently as pancreatic cancer, as breast cancer, brain cancer and so on, there's no area of the body that should escape the scrutiny of this survey that's now going on. And hopefully at our conference that we run Britain Against Cancer later this year the chances are the minister, Alan Johnson, we hope will report on what they're going do about this and cancer - lung cancer must be part of that whole process, whether it's prevention, whether it's understanding genetics, whether it's clinical trials. My belief and I think the committee's belief would be that we're going to have to put more resource and determination into all the cancer that we're afflicted with. ROBINSON Professor Seckl is it true that the money flows follows the breakthroughs and so if there haven't been these big breakthroughs with lung cancer and there haven't then of course you haven't had masses of funds? SECKL It's sort of a chicken and egg situation really and if you put money in you generally speaking get things out, if you don't put money in then you're unlikely to get anything out. I think there is a real need to see a dedicated fund for lung cancer research in the country and I think until we have a real opportunity for people to bid specifically for lung cancer research I think there's going to be an under resourced research community for lung cancer. ROBINSON Tell me about the research that you do. SECKL We have opted to focus on understanding the mechanisms underlying resistance of the cancer to the existing therapies because this is the principle reason why people die of the disease. And I'm pleased to say that we have made some quite revealing breakthroughs in the last few years. So, for example, one of the features which are - represent a very poor prognostic factor for patients with lung cancer is having an elevated level of a particular growth factor in the blood and nobody understood why this particular growth factor gave rise to such a poor outcome. But our laboratory research has now revealed an underlying mechanism for this and we now have now small molecule drugs that seem to work well in models of lung cancer and we hope that we'll be able to take this through into clinical trials. But of course if we hadn't been able to do this research we wouldn't be in a position of having this kind of breakthrough. ROBINSON When it comes to fighting cancer of course the big thing with lung cancer would be to try to get people who are smoking to give up and people who have never smoked not to even start. Professor Gerard Hastings is a big expert on all that, he's director of the Institute for Social Marketing and Centre for Tobacco Control Research at Stirling University and he was part of the EU committee that proposed these pictures warning on cigarette packets of what might happen to your lungs. You obviously think they will work. HASTINGS Yes there's good evidence that they do indeed, this is not - we're not the first country to have gone down this route - Canada and Brazil, for instance, have had these for some years now. And you can see that as part of lots of other things you need to do to discourage smoking they play a useful role. ROBINSON As I understand it you hope these pictures might be the turning point for some individuals but in order to get off cigarettes you have to reach that turning point sometimes many, many times and keep on and on trying to give up. HASTINGS Yes and one of the advantages of warnings on packs of course is that they're there all the time - every time you have a cigarette it's there, it's absolutely perfect targeting in that sense. But most smokers are like Kenny, they wish they hadn't started and would very much like to give up and we need to recognise that and try and support them. ROBINSON If you were in charge of it all what would you do with tobacco marketing law? HASTINGS I would strengthen it, I think it's very good that these warnings are coming in but one has to step back and think well still a lot of the pack is not being used to give out health education, it's been given over to tobacco companies to promote their evocative brands. So first of all I would see the whole pack as a platform for health information and nothing else. I would ask very serious questions about why we still have so many different sorts of cigarettes so readily available, so every kid in the land goes in to spend their pocket money and is accosted by a great display of different sorts of cigarettes and you know if this were cocaine you would think that was absolutely perverse. And I would seriously question why we have so many outlets at all, why is it so easy to get hold of? Any smoker will tell you where they can get cigarettes 24 hours a day. ROBINSON Joyce Dunlop from the Roy Castle Lung Cancer Foundation, given that money's always going to be limited do you think we're spending what we do have to spend on lung cancer in the right way? DUNLOP I think that the emphasis is too much on the smoking side of the disease, we would like to see more research being done on the 10% of people who there is absolutely no indication as to why they develop the disease and in a lot of these patients the disease is very, very aggressive. So in the ideal world where nobody's smoking anymore lung cancer will still be here and therefore we'd like to see more research into things like that. ROBINSON Ian Gibson what do you think about this business of whether we're spending what we have on the right treatments and things? GIBSON Well I think the government has to spend a huge sum, more than it has done, I mean an awful lot of research comes from the magnificent charities in this country of which we've got 600 or more who collect money on street corners and from legacies and they put money into research and without them I don't think we'd even know what we know now about cancer. I think we have to have a policy that is pound for pound, you know, every charity gets a pound for every pound it collects or else we give them VAT special status or whatever and we encourage it, that that research goes on. But I think at the same time the research has to cover the whole field of prevention right through to palliative care of the individual and that's a big, big change I think in cancer that we understand the patient goes through that whole journey now and we have to have better research at different levels. SECKL I was going to suggest why is that we can't add more money on to the cost of a cigarette and then use that money directly to fund lung cancer research? ROBINSON We'll have to leave it there, some very interesting ideas. Thank you all very much taking part. Back to the You and Yours homepage The 成人论坛 is not responsible for external websites |
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