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Tuesday, 30 July 2013
Real Housewife Teresa Giudice, hubby face real fraud charges
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New Jersey among states that are most vulnerable to rising sea levels, study says
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Bringing portraits to life
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Mooij named Monmouth County Superintendent of the Year
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Lawyers confirm NJ judge lived with accused robber
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popculturebrain: Watch Edgar Wright, Simon Pegg, and Nick...
popculturebrain:
Watch Edgar Wright, Simon Pegg, and Nick Frost’s Funny Alamo Drafthouse Don’t Talk PSA | Badass Digest
I have to say that the Drafthouse PSAs are seem really out of context, if not actually in a theatre.
But fortunately for seemingly most of a America, if there is not a Drafthouse near you, there will be soon. The franchise has grown drastically in the last two years. Just don’t ask Austinites how this has affected the menu. :/
popculturebrain: Watch Edgar Wright, Simon Pegg, and Nick...
popculturebrain:
Watch Edgar Wright, Simon Pegg, and Nick Frost’s Funny Alamo Drafthouse Don’t Talk PSA | Badass Digest
I have to say that the Drafthouse PSAs are seem really out of context, if not actually in a theatre.
But fortunately for seemingly most of a America, if there is not a Drafthouse near you, there will be soon. The franchise has grown drastically in the last two years. Just don’t ask Austinites how this has affected the menu. :/
NJ flood victims face difficult buyout decision
Sorry, I could not read the content fromt this page.Sorry, I could not read the content fromt this page.
News digest – suffocating tumours, standardised tobacco packs, skin cancer and more
This week’s cancer newsThe big science story this week came from our labs. Our researchers found a way to stop cancer cells coping with low oxygen levels, which could open the door to new treatments that suffocate tumours. We looked in-depth at the research here.The major public health story came from Australian shores, where new research showed that plain cigarette packs encourage smokers to quit. This underlines just how wrong our Government is to put their decision on standardised tobacco packaging on hold. Here’s our news story, and this is the BBC’s take.Our research showed that one third of people diagnosed with throat cancer are infected with a form of the HPV virus. The Guardian has more detail.Good news – more than eight in 10 people with the most serious form of skin cancer, malignant melanoma, now survive their disease. The Independent has more info.A radioactive drug can improve survival rates in men whose prostate cancer has spread to their bones, as well improve their quality of life. Read our news story.Our scientists found a link between higher levels of sex hormones and an increased risk of breast cancer in premenopausal women. Here’s our press release.And finally
Research confirmed the link between a woman’s cancer risk and her height. Medscape has more info. The link could be related to a woman’s genes, the levels of hormones and growth factors in her blood, or simply be down to taller bodies generally having more cells.‘Chocolate detects cancer’ headlines are misleading
No, chocolate can’t detect cancer. Sorry.Much to the (misplaced) joy of chocoholics everywhere, the Daily Mail’s headline yesterday proclaimed “Chocolate and fizzy drinks could be used as cancer detectors because malignant tumours feed off sugar”. Unfortunately, this is a gimmicky, inaccurate misrepresentation of what is actually a fascinating and important experimental research finding.
The story is based on a paper, published in the journal Nature Medicine, by scientists at University College London (UCL). They’re part of the UCL and KCL Comprehensive Cancer Imaging Centre, which is jointly by Cancer Research UK and the EPSRC. They’re developing a new scanning technique, GlucoCEST, which detects glucose – a type of sugar – taken up by cancer cells in mice.
The scientists injected animals with a solution of pure glucose dissolved in salty water, using a relatively small amount of the sugar. Scaling it up, the researchers suggest that in human trials (which are underway), volunteers would need to take in around 14 grammes of glucose – about the same as the amount found in half a standard size chocolate bar.
But – here’s the crucial point – people in the trial would need to fast beforehand, and would drink glucose in the form of a controlled sugar solution rather than chomping a Mars Bar or glugging a can of cola.
Other news outlets managed to report the research – which, as we’ll see below, is extremely exciting – with rather more accurate headlines (for example, “New MRI technique uses spoonful of sugar to detect cancer”). So what’s this research all about, and why is it important?
Researchers have known for many years that cancer cells produce energy and use sugar slightly differently from healthy cells. Tumours tend to favour a relatively inefficient process called glycolysis to make energy from glucose, burning through the sugar at an impressive rate.
But healthy cells use glycolysis to produce smaller molecules that they then feed into a different cellular ‘engine’, which puts out more energy for a given amount of glucose than glycolysis alone. So healthy cells generally get much more bang for their glucose buck, so to speak.
PET scans use radioactive glucose to detect tumour activityThis difference between cancer cells and healthy tissue is already used to monitor the disease – for example, PET scans measure how tumours absorb small doses of radioactively-labelled glucose.
But giving people radioactivity, even in small amounts, carries a slight health risk, especially with repeated scans. And it means that they aren’t so suitable for people who are more vulnerable to the effects of radiation, such as pregnant women and children.
So the UCL team set about developing a scanning technique that could detect the differences in glucose use between tumours and healthy cells, without having to resort to using radioactivity.
They decided to use a technique called MRI scanning, or magnetic resonance imaging, which looks at how different molecules ‘wobble’ when they’re inside a strong magnetic field. It usually picks up signals from fat and water molecules, building up a picture of the tissue inside the body, and is already used in the NHS to detect and monitor cancer.
In this study, the researchers adapted their MRI scanner to look for certain characteristic signals of glucose, rather than fat or water, on the basis that bowel tumours should have higher levels of the sugar than healthy tissues.
The scientists discovered that their technique could accurately detect bowel tumours in mice just as well as other methods. And they also found that it was sensitive enough to tell the difference between different types of bowel tumour, as well as picking up areas of tumours with relatively low oxygen levels, and could also detect other glucose-like molecules that are involved in energy production.
The UCL team is now testing their technique, called GlucoCEST, with patients, although – as we’ve mentioned – these volunteers definitely won’t be getting a choccy bar in the scanner, but are being given a glucose solution to drink. They need to find out if it works in humans as well as it does in mice, and whether giving glucose to people to drink produces a good enough signal, or whether they’d need to inject it instead.
There is a pervasive belief, particularly among alternative-medicine fans, that sugar “feeds cancer cells”. This is an unhelpful oversimplification of a highly complex area that researchers are only just starting to understand.
“Sugar” is a catch-all term, referring to a range of molecules including glucose and fructose –simple sugars found in plants – and sucrose, the white stuff in the bowl on your table, which is a made from glucose and fructose stuck together. And sugars fall under the banner of carbohydrates (“carbs”) – molecules made from carbon, hydrogen and oxygen. This also includes starch, found in foods like bread and pasta, which is made of long chains of glucose molecules.
When we eat food containing carbohydrates – whether it’s a cake or a carrot – they get broken down in our digestive tract to release glucose and fructose, which get absorbed into the bloodstream to provide energy for us to live.
All our cells, cancerous or not, use glucose for energy. But because cancer cells are usually growing very fast, compared to healthy cells, they have a particularly high demand for this fuel. As we mentioned above, there’s also evidence that they use glucose and produce energy in a different way to healthy cells. And it’s the high demand for glucose in tumours that’s the basis for the UCL team’s new technique.
Researchers around the world – including those funded by Cancer Research UK – are working hard to understand the differences in energy usage in cancers compared to healthy cells, and trying to exploit them to develop more effective treatments (including the infamous DCA). This field, known as “tumour metabolism”, is an extremely hot topic, but there aren’t yet any effective drugs targeting cancer metabolism that have been shown to work in large-scale clinical trials.
But all this doesn’t mean that “sugar” (i.e. sucrose in cakes, sweets and other sugary foods) specifically “feeds” cancer cells, as opposed to any other type of carbohydrate. Our body doesn’t pick and choose which cells get what fuel – it converts pretty much all the carbs we eat to glucose, fructose and other simple sugars, and they get taken up by tissues as and when they’re needed.
We recommend that cancer patients and the general public limit sugary foods as part of an overall healthy diet, but it’s not clear that eating sugary foods specifically “feeds” cancer cells. It’s important that cancer patients discuss their diet with their doctor or specialist nurse before making any big changes – for example, some people may be advised to have a high-calorie diet during chemotherapy to help cope with the effects of treatment.
Although it still needs to be fully tested, if GlucoCEST works in patients it could potentially be very important. The technique could be rolled out relatively quickly using the existing MRI scanning technology available in the NHS. It’s also likely that it would be cheaper than PET scans, although there’s some variation in how much the two techniques cost to run. And it also avoids the need to use radioactive glucose, making it safer and suitable for all patients.
Figuring out how cancer is behaving in the body – knowing where it is, how it’s growing, and whether it’s responding to drugs – is vitally important. If it works in patients, and if it does become widely used, GlucoCEST could help doctors decide the best approach for treatment for an individual patient, and accurately monitor how their disease is responding to therapy. Right now, we simply don’t know whether it will work in patients, but we look forward to seeing the results of the team’s clinical study when they’re published.
It may seem like nit-picking or pedantry to complain about the coverage of this paper or, indeed, any of the other times we’ve criticised the way a particular science story is covered, such as the recent “HIV cures dying girl” episode. But we write these posts because we strongly feel that it’s important that we provide easily understandable, accurate and – hopefully – engaging and interesting coverage of the latest progress in cancer.
We’re living in a hugely exciting time for cancer research, with advances in understanding and technology accelerating year on year, bringing significant improvements in survival along with it. Yet it does a great disservice to patients and the public if the media, researchers and funders fail to find ways to talk about these impressive advances in a way that captures the imagination, yet maintains scientific accuracy.
Misleading, over-hyped or just plain wrong headlines help no-one. They lead to confusion about the current state of research, and reinforce unhelpful narratives about what “they” (i.e. scientists) think is “good for you”, “bad for you”, can “cure cancer” or whatever else.
Sadly, certain headlines about this particular paper are an inaccurate reflection of what is an important and potentially very useful piece of research, which should demand attention on its own merits, rather than resorting to gimmicks.
Kat
Reference:
Walker-Samuel S., et al. (2013). In vivo imaging of glucose uptake and metabolism in tumors., Nature medicine, PMID: 23832090
It may seem unlikely, but could a statistician save your life?
Data can save livesIdentifying where a health service is doing well – and where it needs to do better – is one of the quickest ways to improve things for patients.
Having reliable, up-to-date figures means those responsible for running the health service can ensure that patients are getting the very best care that the public rightly demands from the NHS.
The shocking revelations about the failings of the mid-Staffordshire hospital are a painful reminder of how important this can be.
But accurate and timely information on healthcare standards can also become a vital resource for the public. Today it’s second nature to search for independent reviews of restaurants, hotels, shops etc.
So why shouldn’t the same be true for our health?
In recent years, the information available to monitor the NHS’s performance has undergone dramatic improvements – and what are called ‘cancer intelligence services’ have been leading the way.
At the National Cancer Intelligence Network (NCIN) ‘Cancer Outcomes’ conference in Brighton last month, data collectors and statisticians across the UK came together to discuss ‘cancer data’, and showed how the data revolution is beginning to put power in the hands of patients.
So how do you know if a hospital is offering high quality care, or whether cancers are being diagnosed at the earliest stage possible?
These are the types of questions that patients, campaigners, politicians, and doctors – as well teams here at Cancer Research UK – are all asking.
In the course of being diagnosed with and treated for cancer you could see a GP, numerous doctors and nurses and undergo multiple diagnostics tests. On top of that, the cleanliness of the hospital, the practicalities of getting to your appointments and your relationships with the medics will all be important.
And this is where the statisticians are increasingly able to help by picking apart the data on all these different areas and transforming it into reliable measures of performance.
In 2007, Professor Sir Mike Richards – then the Government’s National Cancer Director – laid down a challenge after news that the UK cancer survival lagged behind a number of other countries: “Quite simply, we want to have the best cancer information service in the world by 2012.”
It was an ambitious target, but one that’s pretty much been met. At the conference Dr Jem Rashbass – National Director for Disease Registration – gave an update on the enormous progress that’s been made to develop the English National Cancer Online Registration Environment – known as ENCORE. The database, which was in its early stages development last year will allow us to ask the NHS questions that were simply not possible to answer before (there’s more in this article on the BBC website).
To protect patient confidentially, the full range of information in ENCORE is carefully controlled. But the snapshot below gives you an idea of what will soon be possible,
The screenshot looks at data on bowel cancer patients who were referred for treatment in the East of England (the lines show where patients were moving between services). It shows the the hospital and clinics they used, and identifies other characteristics such as the stage at which they were diagnosed
The screenshot also shows that patients are not simply treated in a single place. It also provides data that allows us distinguish the outcomes between different groups of patients. For example we can look at the effects of stage and age at diagnosis on the treatments patients receive and also look at their survival.
The ENCORE system (Click to enlarge)Using this information we can identify how to improve things for patients. For example, if a lot of patients were diagnosed late then action should be taken to increase early diagnosis.
But as well as looking at differences within groups of patients in the same area, it can also be helpful to compare different areas, to see what’s working, and what’s not.
We’re all familiar with this on travel and review websites; comparisons offer a simple way to spot the best places to go.
One of the benefits of the improving quality and detail of information in databases like ENCORE is that it will increasingly enable us to make more comparisons between different parts of the country, hospitals and even individual surgeons.
For example, the NHS recently published information on consultant led surgical teams for a range of diseases across England including death rates. Those surgeons who refused to do so were ‘named and shamed’. (The information can be found on the NHS Choices website)
But this comes with a huge caveat. It’s not easy to make these kinds of comparisons in health care.
It’s not enough just to compare outcomes for patients with the same disease. Firstly – as pointed out in a recent paper in the Lancet – we need to have a large enough number of patients to know the results are a fair reflection of overall performance, otherwise the statistics are meaningless.
To compare things accurately and meaningfully, we also need to know that patients were diagnosed at the same stage and age, had similar levels of general health and other factors that influence how likely they are to survive. And we need to bear in mind that they may have attended several hospitals during their treatment.
Without these criteria the performance of hospitals or clinicians could be unfairly called into question. For example a specialist surgeon who operates on more of the most difficult to treat patients may have worse results than someone operating on patients who are easier to treat.
But these obstacles are becoming less of a problem the more data we have to tackle them.
After the whizz-bang of ENCORE, Professor Henrik Moller from Kings College London presented some fascinating statistics, looking at the differences between hospitals that treated the most oesophageal and gastric (upper GI) cancer patients, compared to those that treat the fewest. (The paper is available online)
The differences in outcomes were largest in short term. Patients who had surgery in hospitals performing the most operations were almost half as likely to die in the first 30 days after surgery than those treated in hospitals performing the least. And even a year after surgery, patients from the higher volume hospitals were still 18 per cent less likely to have died.
Although this analysis can’t explain what is causing these differences, it can show us the areas to investigate. For example:
Is a hospital operating on large numbers of patients better set up to care for them before and/or after surgery, and are its surgeons more technically skilled?Alternatively, are hospitals with better outcomes simply more likely to have patients referred to them and therefore treat more patients, rather than better outcomes simply being the result of treating larger numbers of patients?And finally could it be that surgeons with better outcomes prefer to work in hospitals treating larger numbers of patients.The answers to these questions may help determine how this work could benefit patients but without knowing there were differences we wouldn’t be asking them.
As this example shows, comparisons done well allow us to identify the best performers and to investigate what they are doing differently. If, by using reliable and meaningful measures, we can show a service is not achieving the best possible outcomes, then the medics themselves, those commissioning services and the rest of us can begin to answer the question: why not?
But as well as making sure people in the health service get the best care, we need to make sure cancer patients are diagnosed as early as possible – something Cancer Research UK and others have been campaigning to achieve. And statistics can identify the groups of people who are more likely to be diagnosed late – a first step towards understanding and improving things.
At the conference, Dr David Greenberg from the National Cancer Registration Service illustrated how powerful this could be. His data showed that in England, an estimated 450 deaths from breast cancer could be prevented every year if the proportion of women diagnosed early in the most deprived groups increased to match that for the least deprived women.
This point was reinforced by Dr Paul Aylin from Imperial College London, who presented research showing that both more deprived and older patients are more likely to be diagnosed with cancer after an ‘emergency’ admission – known to be linked to lower survival rates for many types of cancer.
Again it’s possible that these groups are being diagnosed later and that some deaths could be avoided if people were aware of the early symptoms of cancer, went to see their GP when they spot them and where necessary are referred on quickly by their GP.
How can we use these stats? One way is to target awareness campaigns at these groups of people and the medics themselves, such as the Government’s recent Be Clear on Cancer campaign, or the work we’ve been piloting around the country we discussed in this recent post.
The work presented at the NCIN conference gives us great optimism about the improvements that can be made by using data intelligently and openly.
The conference brought together people from across a wide range of disciplines within the health service – as well as from charities like Cancer Research UK – and showcased work on every aspect of patient’s interactions with health care – from diagnosis and treatment, to the quality of conversations taking place with their doctors and end of life care.
But of course the ultimate goal of all of this isn’t just data for the sake of data – it’s to provide clear and reliable measures of where the NHS is doing well and where it could do better, and ensuring we can all use that information. This is the start of the information revolution and we are beginning to make a difference.
Cancer Research UK’s own Cancer Statistics section of our website is the leader in UK cancer statistics and we’ll be making sure we help make all this new information available to everyone. Yesterday we launched an exciting new addition to our website which makes local statistics available to health care commissioners, politicians and everyone else interested in them.
We statisticians are doing much more than providing a market for “I love spreadsheets” mugs: we’re using patient data to save people’s lives.
Matt
Matt Wickenden is a senior statistical officer at Cancer Research UKImage of ENCORE provided by Dr Jem Rashbass; other image via Wikimedia Commons
News digest – suffocating tumours, standardised tobacco packs, skin cancer and more
This week’s cancer newsThe big science story this week came from our labs. Our researchers found a way to stop cancer cells coping with low oxygen levels, which could open the door to new treatments that suffocate tumours. We looked in-depth at the research here.The major public health story came from Australian shores, where new research showed that plain cigarette packs encourage smokers to quit. This underlines just how wrong our Government is to put their decision on standardised tobacco packaging on hold. Here’s our news story, and this is the BBC’s take.Our research showed that one third of people diagnosed with throat cancer are infected with a form of the HPV virus. The Guardian has more detail.Good news – more than eight in 10 people with the most serious form of skin cancer, malignant melanoma, now survive their disease. The Independent has more info.A radioactive drug can improve survival rates in men whose prostate cancer has spread to their bones, as well improve their quality of life. Read our news story.Our scientists found a link between higher levels of sex hormones and an increased risk of breast cancer in premenopausal women. Here’s our press release.And finally
Research confirmed the link between a woman’s cancer risk and her height. Medscape has more info. The link could be related to a woman’s genes, the levels of hormones and growth factors in her blood, or simply be down to taller bodies generally having more cells.Sparking the radiotherapy revival
- David Cameron, September 2012Radiotherapy cures more patients than cancer drugs
“We already have a guarantee for drugs – that if they’re safe, cost-effective and doctors say you need them, you will get them.
From April 2013, for the first time ever, we’re extending that guarantee to radiotherapy too.
This is going to help thousands of people at one of the hardest times of their lives.”
Last year was a breakthrough year for radiotherapy. We have been talking about radiotherapy’s importance, and the need for better awareness and investment, for a number of years, including through our Voice for Radiotherapy campaign, which called on Government to tackle inequalities in access.
But in September 2012, this culminated in the Government launching the Radiotherapy Innovation Fund – initially £15 million but later boosted to £23 million – to help NHS Trusts in England provide more patients with access to advanced radiotherapy.
Today, Cancer Research UK, the Institute of Physics and Engineering in Medicine, The Royal College of Radiologists and The Society and College of Radiographers have published a report evaluating its impact.
It’s easy to see why the Fund has been such a good news story in England. It was set up to help the country’s 50 radiotherapy centres deliver more of an advanced form of treatment called Intensity Modulated Radiotherapy (IMRT) to suitable patients.
This allows the radiotherapy beam to be more targeted to a patient’s cancer and therefore cause less damage to surrounding healthy issue, and can help reduce the side effects – as the images below demonstrates.
Intensity-modulated radiotherapy, or IMRT, delivers a lower dose to a patient’s tissuesThis particular form of radiotherapy has been around for a while, but many of the radiotherapy services in England just haven’t had the capacity to give it to their patients.
At the time of the Prime Minister’s announcement, on average fewer than 14 per cent of patients were receiving IMRT, well below the recommended 24 per cent.
Our report shows that, following the delivery of the Fund, the average delivery of IMRT in April 2013 was up to over 22 per cent – a fantastic achievement in such a short space of time.
This means that around 5,800 more patients across England will now be in line to benefit from IMRT than last year. We expect that this figure will keep on rising.
IMRT also can avoid damaging organs like the salivary glands, reducing side-effectsSo how did this come about?
Each Trust used their allocation to buy specialist equipment and to train staff to perform IMRT. This sort of investment means that hospitals across England are in a better position to give advanced radiotherapy.
Before last year, the radiotherapy service in England had been underfunded and neglected, despite the crucial role it plays in cancer treatment.
Now that Government, the NHS and hospitals are becoming more aware of its importance we must maintain the momentum and continue to push for improvements.
But the work doesn’t stop here – as well as IMRT, there are still other types of radiotherapy that some patients are missing out on, which we think the NHS should be doing more to provide. These involve using imaging in real time to track the treatment (so-called ‘image-guided’ radiotherapy, or IGRT), and using smaller, more accurate beams.
But much more importantly, we have some serious concerns about the long-term capabilities of the NHS to cater to the increasing need for radiotherapy.
As cancer rates increase, and we get better at diagnosing the disease earlier – which gives us more opportunity to treat the tumour with radiotherapy – the demand on radiotherapy services will increase. But many of the machines currently in use are getting older and need replacing.
As we discussed last year, the Department of Health estimates that funding needs to be found for 254 new machines in the next three years to keep up with demand.
Today’s report helps to show the NHS and Government how a comparatively small investment into radiotherapy services in England can deliver a significant benefit to cancer patients. We think that the Fund should be the foundations for more sustained investment into radiotherapy in order to give England the world class service that it needs.
A final note – it’s worth pointing out that because the different nations of the UK have devolved healthcare systems, these announcements are related to England. We are continuing to work with the governments of Wales, Scotland and Northern Ireland to make sure that patients in these countries have access to the radiotherapy and the most recent techniques.
We’ll be covering these issues in future blog posts.
Dan Bridge
Sparking the radiotherapy revival
- David Cameron, September 2012“We already have a guarantee for drugs – that if they’re safe, cost-effective and doctors say you need them, you will get them.
From April 2013, for the first time ever, we’re extending that guarantee to radiotherapy too.
This is going to help thousands of people at one of the hardest times of their lives.”
Last year was a breakthrough year for radiotherapy. We have been talking about radiotherapy’s importance, and the need for better awareness and investment, for a number of years, including through our Voice for Radiotherapy campaign, which called on Government to tackle inequalities in access.
But in September 2012, this culminated in the Government launching the Radiotherapy Innovation Fund – initially £15 million but later boosted to £23 million – to help NHS Trusts in England provide more patients with access to advanced radiotherapy.
Today, Cancer Research UK, the Institute of Physics and Engineering in Medicine, The Royal College of Radiologists and The Society and College of Radiographers have published a report evaluating its impact.
It’s easy to see why the Fund has been such a good news story in England. It was set up to help the country’s 50 radiotherapy centres deliver more of an advanced form of treatment called Intensity Modulated Radiotherapy (IMRT) to suitable patients.
This allows the radiotherapy beam to be more targeted to a patient’s cancer and therefore cause less damage to surrounding healthy issue, and can help reduce the side effects – as the images below demonstrates.
Intensity-modulated radiotherapy, or IMRT, delivers a lower dose to a patient’s tissuesThis particular form of radiotherapy has been around for a while, but many of the radiotherapy services in England just haven’t had the capacity to give it to their patients.
At the time of the Prime Minister’s announcement, on average fewer than 14 per cent of patients were receiving IMRT, well below the recommended 24 per cent.
Our report shows that, following the delivery of the Fund, the average delivery of IMRT in April 2013 was up to over 22 per cent – a fantastic achievement in such a short space of time.
This means that around 5,800 more patients across England will now be in line to benefit from IMRT than last year. We expect that this figure will keep on rising.
IMRT also can avoid damaging organs like the salivary glands, reducing side-effectsSo how did this come about?
Each Trust used their allocation to buy specialist equipment and to train staff to perform IMRT. This sort of investment means that hospitals across England are in a better position to give advanced radiotherapy.
Before last year, the radiotherapy service in England had been underfunded and neglected, despite the crucial role it plays in cancer treatment.
Now that Government, the NHS and hospitals are becoming more aware of its importance we must maintain the momentum and continue to push for improvements.
But the work doesn’t stop here – as well as IMRT, there are still other types of radiotherapy that some patients are missing out on, which we think the NHS should be doing more to provide. These involve using imaging in real time to track the treatment (so-called ‘image-guided’ radiotherapy, or IGRT), and using smaller, more accurate beams.
But much more importantly, we have some serious concerns about the long-term capabilities of the NHS to cater to the increasing need for radiotherapy.
As cancer rates increase, and we get better at diagnosing the disease earlier – which gives us more opportunity to treat the tumour with radiotherapy – the demand on radiotherapy services will increase. But many of the machines currently in use are getting older and need replacing.
As we discussed last year, the Department of Health estimates that funding needs to be found for 254 new machines in the next three years to keep up with demand.
Today’s report helps to show the NHS and Government how a comparatively small investment into radiotherapy services in England can deliver a significant benefit to cancer patients. We think that the Fund should be the foundations for more sustained investment into radiotherapy in order to give England the world class service that it needs.
A final note – it’s worth pointing out that because the different nations of the UK have devolved healthcare systems, these announcements are related to England. We are continuing to work with the governments of Wales, Scotland and Northern Ireland to make sure that patients in these countries have access to the radiotherapy and the most recent techniques.
We’ll be covering these issues in future blog posts.
Dan Bridge
Standardised tobacco packs shelved – an ‘extraordinary’ decision
We’re not happy“It’s official – Govt gives up on public health policy” was how one tweet summed-up the announcement today that the government has put its plans to introduce standardised tobacco packaging on hold.
The statement that accompanied the consultation response offered the explanation that the government “has decided to wait until the emerging impacts of standardised tobacco packaging in Australia”.
It’s a reason we don’t accept, because doing nothing while 570 children start smoking every day in the UK, is simply not an option.
Public health has been a duty of government since the Romans built aqueducts – yet the public health of society’s most vulnerable is being inexcusably neglected here; children being lured into an addiction that kills one in two of its long-term users.
This decision means that lives will be lost.
That’s why our message of defiance is clear. The government may think that they can ‘kick this into the long grass’ but the spotlight on the issue has only brought it sharper into focus, and we’re unequivocal that standard packs will not be cast into the wilderness.
You only need to look at some of today’s media coverage, to determine the nationwide interest in this issue:
Just a quick look at Twitter highlights the full-extent of anger from politicians, public health experts and public alike. And if you need a reminder of why this is so urgent, watch this video:
This was a UK-wide consultation, and health ministers in the devolved nations – Scotland, Wales and Northern Ireland – had already written to Jeremy Hunt urging him to press-ahead with standard packs UK-wide.
With today’s announcement, signalling that their wishes have been ignored, Scotland has moved onto the front-foot and is “still committed” to standardised packaging. We fully welcome this re-commitment.
Our Chief Executive Dr Harpal Kumar called the decision “extraordinary” on Radio Four’s Today Programme, referring to the overwhelming evidence that standard packs will make tobacco less attractive to children.
It would be extraordinary if the government truly believed they could hide-away standard packs in the long grass. Because, to paraphrase a Prime Minister who didn’t shy away from a fight, our message is simple: ‘We will fight them in the long grass – we will never surrender’.
Chris
Don’t let the Government surrender to the tobacco industry and stand by as lives are lost – email David CameronTaking down the boss – stopping tumours coping with low oxygen levels
The two halves of HIF-1, unified to help cells adapt to low oxygen levelsAll cells need oxygen to survive, whether they’re healthy or cancerous. As a tumour grows bigger, oxygen levels inside it start to fall and the cells start to struggle. But some cancers, particularly aggressive and harder to treat forms of the disease, can evolve ways to get round this problem and continue thriving.
One way cancer cells adapt to these low oxygen conditions is by sending out signals to attract new blood vessels to grow into the area where oxygen is scarce – a process scientists call angiogenesis. These new vessels form a pipeline that carries oxygen deep into the tumour, keeping it growing.
For a while, scientists thought that stopping tumours growing blood vessels was the ‘silver bullet’ that would cure many cancers simply by starving them of oxygen. But drugs that target this process have not lived up to their hype. One reason for this may be that blood vessel growth is only a small part of the way cells adapt to low oxygen, and blocking that by itself is not enough to kill the cancer.
In a new paper, Dr Ali Tavassoli and his team at the University of Southampton have taken a step forward in developing a drug to stop cells adapting to scarce oxygen environments. To do this, they’ve discovered a way to tackle the mastermind of the oxygen operation: a protein called HIF-1.
Cells can adapt to low oxygen levels by switching on a protein called ‘hypoxia-inducible factor’, or HIF-1 for short. HIF-1 is a type of protein called a transcription factor, which can stick to the DNA in a cell’s nucleus and switch other genes on or off.
As a result, HIF-1 acts a molecular ringleader, controlling a whole network of around 300 other proteins made by these genes. These proteins then act in concert to help the cells cope with low oxygen levels: for example by causing new blood vessels to grow into pockets of low oxygen, and by changing the way the cells’ engines burn fuel to use up less of this precious resource.
This whole process is known as the ‘HIF response’ – and working out how to switch it off could be a powerful way to tackle cancer.
“HIF-1 is special”, explains Dr Tavassoli, “as it is the central controller of the response to low oxygen levels. Its effect on angiogenesis is just one of several changes that it causes in cells to try and allow them to adapt.
“By targeting HIF-1, we are targeting all aspects of the cells’ escape route, not just one of them.”
So how does the HIF-1 protein work? Researchers have previously discovered that the HIF protein is made of two parts, known as HIF-1-alpha and HIF-1-beta. Normally these exist separately in the cell. But when oxygen levels are low, these come together like star-crossed lovers to make a whole functioning protein. Critically, HIF-1 can only bind DNA and turn genes on once the two halves have stuck together in this biological clinch, which researchers call a ‘protein-protein interaction’.
As any keen detective knows, the best way to fight a criminal gang is to go for the ringleader. So Dr Tavassoli and his team decided to try to stop the two halves of HIF combining, to see if they could shut down the entire low oxygen response and stop the cancer cells adapting.
This may sound simple, but it’s actually an incredibly challenging task.
Transcription factors and protein-protein interactions are notoriously difficult to target with drugs. Nature has designed the proteins to come together transiently like a one-night stand; they meet to do their job then fall apart again. This means the forces connecting them are balanced between being strong enough to hold them together for a while but weak enough for them to release each other after their tryst.
Targeting this transient and relatively weak attraction with drugs is much more difficult than blocking a strong, specific fit where the scientists have a clear picture of the precise shape a drug needs to be (like the interaction between the leukaemia drug imatinib and its target). Indeed, transcription factors like HIF-1 are often referred to as “undruggable targets”.
“Small molecules traditionally tested as drugs are not effective against protein interactions, because their surfaces are often flat and featureless landscapes, with nowhere for small molecules to stick”, explains Dr Tavassoli.
To try to target HIF-1, they had to turn to a new class of molecules – small, ring-shaped, protein-based entities called ‘cyclic peptides’, made from building blocks called amino acids (the units all proteins are made from). These can settle onto the relatively flat surfaces of biological molecules, disrupting their function or ability to interact with other proteins.
In particular, Dr Tavassoli’s team focused on cyclic peptides made of a ring of just six amino acids.
But each of the building blocks can be one of 20 different naturally occurring amino acids, which means in total there are 3.2 million possible combinations. Yes, you read that correctly – if you have 20 different possible building blocks, just six of them can be arranged in more than 3 million ways. And the scientists made and tested them all.
To make and test such a vast number of cyclic peptides, the researchers employed the help of bacteria called E. coli. They genetically modified different samples of these handy little bugs so that they were able to make three new molecules: the alpha and beta parts of the HIF-1 protein, along with a single one of each of the 3.2 million cyclic peptides. This created a collection of more than three million different bacteria strains.
But here’s the really clever part. Dr Tavassoli’s team had also genetically modified the bacteria so that, if HIF-1’s two halves became a whole, the protein would turn off the bacteria’s ability to protect themselves from antibiotics.
The researchers then grew each of these strains of bacteria in Petri dishes containing antibiotics, which had one of two outcomes.
If a strain produced a cyclic peptide that did not block the two halves of HIF-1 binding, then HIF-1 would turn off the bacteria’s defences, and the strain would die.
But if the bacteria’s cyclic peptide did block HIF-1’s embrace, then HIF-1 wouldn’t switch off the survival genes, so the bacteria would grow and thrive.
So all the researchers had to do was take their collection of 3.2 million strains of modified bacteria, grow each one in antibiotics, and wait. Any bugs that managed to grow would be carrying a potential HIF-1 inhibitor in the form of a cyclic peptide that could be easily identified by a quick genetic analysis.
This quick test and rapid growth of E. coli meant that the scientists were able to screen all of the 3.2 million cyclic peptides in just 48 hours. To test this number of drugs without the help of the bacteria would have taken many, many years.
And this is how they uncovered the cyclic peptide called ‘cyclo-CLLFVY’ – one in 3.2 million. After more experiments to double check their discovery, further research in human cancer cells grown in the lab proved that it was working exactly how they wanted, blocking the two parts of HIF-1 from sticking together and binding DNA.
So when cancer cells treated with the cyclic peptide were grown in low oxygen levels, they weren’t able to turn on the HIF response anymore.
And this is why this research is so exciting – for the first time Dr Tavassoli and his team have discovered a way to selectively disrupt the HIF-1 rendezvous.
Researchers have tried to target the HIF response before. But the experimental drugs they’ve created have all been targeted at HIF-1’s ‘henchmen’ rather than the boss itself, blocking one or two of the 300 or so proteins that HIF-1 controls. But to hit cancer cells where it really hurts, shutting down the entire HIF response from the top down might be a far more effective strategy. And Dr Tavassoli’s approach is the first molecule that specifically targets HIF-1.
This new cyclic peptide can also be used to reveal more about the biology of the HIF response. Like a Mafia clan, there are other family members in the wings – there are two related types of HIF, HIF-2 and HIF-3. No one is yet sure what they all do – there is even some evidence that they oppose each other. Blocking one type of HIF might have an anti-cancer effect, while blocking another might support cancer’s growth. Finding out more about how HIF works could be the key to targeting it successfully with drugs.
So could cyclo-CLLFVY be given to patients? Not yet.
Cyclic peptides have some serious drawbacks as medicines. They usually can’t be taken as a simple tablet a patient could swallow and absorb into their bloodstream. It’s also difficult to get cyclic peptides into cells, and they won’t be effective unless they can get to where they are needed.
But even though this little molecule may not be useful as a drug in its current form, the discovery does give medicinal chemists a great springboard from which to develop drugs that could block HIF-1. By knowing the shape and composition of the cyclic peptide, they can mimic it with chemicals that have extra properties more suited to being a medicine.
It’s also a great proof of principle. By showing that this technology works, researchers can start hunting down cyclic peptides that block other transcription factors central to cancer. It may be the first step on the road, but there’s a lot of potential for this exciting technology. We can’t wait to hear more.
Emma Smith
Reference
Miranda E. et al. (2013). A Cyclic Peptide Inhibitor of HIF-1 Heterodimerization That Inhibits Hypoxia Signaling in Cancer Cells, Journal of the American Chemical Society PMID: 23796364
TRACERx – a new era in lung cancer research
Ceri with her daughter Leoni, before Ceri passed awayAt the turn of the millennium, Bill Clinton stood in front of the White House to announce a milestone in scientific and human history.
Scientists had produced a map of our DNA, a breakthrough that was set to revolutionise medicine, and our understanding of diseases like cancer.
Nobel prizes were awarded. Progress was promised.
Eight years later, Tracey and Heidi’s sister Ceri was diagnosed with a form of lung cancer. She was just 34. She had an 11 year-old daughter. She died the following year.
For all the promise, fanfare and hype – to say little of the billions of dollars spent on molecular cartography – the map of human genome had done precious little to save her.
Lung cancer is a terrible disease. It develops covertly, is usually diagnosed late, and rapidly develops resistance to treatment. As a result, it claims nearly 35,000 lives in the UK each year (and an estimated 1.4 million worldwide). Survival rates have only improved fractionally in forty years.
This needs to change.
Today we’re announcing a multi-million pound research project – TRACERx – that will exploit the map of the human genome to explore, in unprecedented detail, what makes lung cancer tick.
Our researchers will be analysing how the genetic changes inside the lung cancers of more than 850 patients change over time, from their point of diagnosis and throughout their treatment.
On top of this, they’ll be throwing a whole suite of cutting edge analytical techniques at these patients’ tumours samples, to understand what’s going on inside them as their cancers grow and spread.
At £14 million, it’s the biggest single investment in lung cancer research we’ve ever made, and the start of a strategic Cancer Research UK-wide focus on the disease. And the end result will be – we hope – a transformation in understanding the disease, and real progress for patients.
Researchers have known for several decades that cancers contain regions of variation – so-called ‘heterogeneity’ – that allow them to evolve in response to treatment. But it’s only in recent years that we’ve had the technological know-how to study this phenomenon in detail.
Researchers have now published a plethora of studies looking at how cancers evolve inside a patient. One in particular caught the public eye in March 2012. Cancer Research UK-funded researchers mapped out the changes in different parts of a patient’s kidney tumour. No two areas were identical. The study shone a spotlight on cancer’s formidable complexity.
The brains behind the study was Professor Charlie Swanton from Cancer Research UK’s London Research Institute – a practicing oncologist at UCLH as well as one of the UK’s leading cancer researchers.
Swanton is determined to map out and understand this heterogeneity in patients’ cancers – not just because of scientific curiosity, but because he wants to make a difference to his patients.
“Understanding the genetic complexity within a tumour and what we call their ‘clonal architecture’ – in other words, the way different groups of cells in a tumour adapt and compete with each other – really is the next frontier in cancer medicine,” he told us. “It’s the explanation for why we generally can’t cure cancer after its spread, and it’s why cancers can foster resistance to even the most cutting edge treatments we have.”
This led him to set up the TRACERx study – a hugely ambitious national collaboration between six clinical centres and four centres of scientific expertise to try to crack lung cancer.
“Lung cancer places a terrible burden on our society, and outcomes are depressingly poor, especially compared to other major cancer types. In terms of ‘unmet medical need’, it’s right up there,” he says.
TRACERx – a journey through space and timeDrawing on the ancient pharmacists’ symbol for a prescription or treatment, ‘Rx’, TRACERx stands for Tracking Cancer Evolution through Treatment (Rx) and will recruit patients with an early stage diagnosis of the most common form of lung cancer – non-small cell lung cancer.
All of these patients will have an operation to remove the tumour in their lungs, which will be sent to the TRACERx team for detailed analysis. At this point the patients may also be offered chemotherapy or radiotherapy.
Then, if and when the patients’ cancer comes back – which it tragically will in many cases – they will be asked if surgeons can take a sample of the recurrent cancer. This too will be analysed – meanwhile the patients will receive further treatment.
And if the cancer comes back after that round of treatment, the patients will again be asked if they will donate tissue samples for further analysis.
And in parallel with all of this – because we now know that signs of cancer DNA can be spotted in the bloodstream – the patients will give blood every three months, which will be stored for analysis at a later date.
As well as tracking patients through time, TRACERx will also bring together expertise through space – in the form of the UK’s enviable network of cancer researchers.
The samples collected throughout the project will be analysed in multiple different ways by different teams around the UK. As well as detailed DNA analysis (of which more below), Dr Sergio Quezada in London and Professor Gary Middleton in Birmingham will look at the involvement of the patient’s immune system in each sample.
And Professor Caroline Dive in Manchester, and Dr Jacqui Shaw in Leicester, will analyse the blood samples for signs of circulating cancer cells or DNA respectively.
All of these researchers are supported by Cancer Research UK. “It’s a pan-CRUK dream protocol,” enthuses Swanton.
But the centrepiece of TRACERx will be the genetic analysis Swanton’s collaborators will be performing.
Rather than analysing the entire 3 billion ‘letters’ of the human genome in each sample, they’ll be using a technique called ‘exome sequencing’, and homing in with precision on the 1.5 per cent of our DNA that encodes our genes – something that wouldn’t have been possible without the human genome project back in the 90s.
But that still amounts to some 51 million ‘letters’ of DNA for each tumour sample.
On top of this, to ensure the results are accurate (after all, one wrong letter is a big deal in genetic terms), they’ll analyse each sample not once, but 500 times over – about 510 million DNA letters in all.
But – uniquely – they won’t just be analysing a single sample. They’ll be analysing six different regions of each patient’s tumour, as well as a sample of their normal tissue for reference. And then even more regions at a later date, if their cancer comes back or spreads.
When you add up the total amount of DNA sequenced for each patient, it amounts to nearly 223 billion letters of DNA.
And they’re doing this for 850 patients.
All in all, TRACERx will be running about 195,075 billion letters of DNA through the DNA sequencing machines at UCL and our London Research Institute, over a nine year period. That’s the equivalent of more than 65,000 human genomes.
No research team has ever looked at lung cancer in this sort of detail before. This is using the map of the human genome to explore completely uncharted territory.
The resulting data will allow Swanton and his collaborators to reconstruct the genetic architecture of each patient’s disease, spotting commonalities and differences, and providing a template for future progress. They’ll be able to answer questions like:
How quickly does genetic variation develop?What processes drive it?How is it related to how patients fare?Can we target variation with drugs?How does treatment affect the development of variation?Are there different ‘types’ of non-small cell lung cancer? (as we’re now finding in breast cancer)Can we predict how a patient’s tumour will behave?What role does the immune system play in the disease?
Tracey and Heidi raise money in Ceri’s memoryThe primary aim of TRACERx – which will begin recruiting later this year – is to understand what lung cancer is – how it adapts and responds to treatment, and where its Achilles heels are (since there are sure to be different vulnerabilities in different patients).
At the outset, no patient will receive any different treatments on the study other than what’s routinely offered on the NHS.
But the data generated will help identify patients who could benefit from existing drug trials – particularly of newer, targeted treatments.
Indeed, the study has already gained the attention of several drugs companies, interested in setting up more trials in the UK. TRACERx will provide a valuable resource to identify patients who could benefit from such trials.
Ultimately, this is about cracking open our understanding of a disease for which there’s an urgent need for progress. That’s something Heidi and Tracey can readily identify with.
As someone who takes part in Race for Life, and has even climbed Mount Kilimanjaro to raise money for research in Ceri’s memory, Heidi told us; “Much more urgently needs to be done to improve treatment for people with this disease, and so we really welcome this £14 million investment from Cancer Research UK.
“Cancer doesn’t care who you are or who you might leave behind. Our family has experienced first-hand the devastation that it causes, and things have to change. And it’s only by doing research that we can beat this terrible disease.”
More than a decade after the publication of the first draft of the human genome, the huge promise offered by that scientific breakthrough is now starting to make its way into studies that will bring real benefits to lung cancer patients – and it’s not a moment too soon.
Henry
TRACERx – a new era in lung cancer research
Ceri with her daughter Leoni, before Ceri passed awayAt the turn of the millennium, Bill Clinton stood in front of the White House to announce a milestone in scientific and human history.
Scientists had produced a map of our DNA, a breakthrough that was set to revolutionise medicine, and our understanding of diseases like cancer.
Nobel prizes were awarded. Progress was promised.
Eight years later, Tracey and Heidi’s sister Ceri was diagnosed with a form of lung cancer. She was just 34. She had an 11 year-old daughter. She died the following year.
For all the promise, fanfare and hype – to say little of the billions of dollars spent on molecular cartography – the map of human genome had done precious little to save her.
Lung cancer is a terrible disease. It develops covertly, is usually diagnosed late, and rapidly develops resistance to treatment. As a result, it claims nearly 35,000 lives in the UK each year (and an estimated 1.4 million worldwide). Survival rates have only improved fractionally in forty years.
This needs to change.
Today we’re announcing a multi-million pound research project – TRACERx – that will exploit the map of the human genome to explore, in unprecedented detail, what makes lung cancer tick.
Our researchers will be analysing how the genetic changes inside the lung cancers of more than 850 patients change over time, from their point of diagnosis and throughout their treatment.
On top of this, they’ll be throwing a whole suite of cutting edge analytical techniques at these patients’ tumours samples, to understand what’s going on inside them as their cancers grow and spread.
At £14 million, it’s the biggest single investment in lung cancer research we’ve ever made, and the start of a strategic Cancer Research UK-wide focus on the disease. And the end result will be – we hope – a transformation in understanding the disease, and real progress for patients.
Researchers have known for several decades that cancers contain regions of variation – so-called ‘heterogeneity’ – that allow them to evolve in response to treatment. But it’s only in recent years that we’ve had the technological know-how to study this phenomenon in detail.
Researchers have now published a plethora of studies looking at how cancers evolve inside a patient. One in particular caught the public eye in March 2012. Cancer Research UK-funded researchers mapped out the changes in different parts of a patient’s kidney tumour. No two areas were identical. The study shone a spotlight on cancer’s formidable complexity.
The brains behind the study was Professor Charlie Swanton from Cancer Research UK’s London Research Institute – a practicing oncologist at UCLH as well as one of the UK’s leading cancer researchers.
Swanton is determined to map out and understand this heterogeneity in patients’ cancers – not just because of scientific curiosity, but because he wants to make a difference to his patients.
“Understanding the genetic complexity within a tumour and what we call their ‘clonal architecture’ – in other words, the way different groups of cells in a tumour adapt and compete with each other – really is the next frontier in cancer medicine,” he told us. “It’s the explanation for why we generally can’t cure cancer after its spread, and it’s why cancers can foster resistance to even the most cutting edge treatments we have.”
This led him to set up the TRACERx study – a hugely ambitious national collaboration between six clinical centres and four centres of scientific expertise to try to crack lung cancer.
“Lung cancer places a terrible burden on our society, and outcomes are depressingly poor, especially compared to other major cancer types. In terms of ‘unmet medical need’, it’s right up there,” he says.
TRACERx – a journey through space and timeDrawing on the ancient pharmacists’ symbol for a prescription or treatment, ‘Rx’, TRACERx stands for Tracking Cancer Evolution through Treatment (Rx) and will recruit patients with an early stage diagnosis of the most common form of lung cancer – non-small cell lung cancer.
All of these patients will have an operation to remove the tumour in their lungs, which will be sent to the TRACERx team for detailed analysis. At this point the patients may also be offered chemotherapy or radiotherapy.
Then, if and when the patients’ cancer comes back – which it tragically will in many cases – they will be asked if surgeons can take a sample of the recurrent cancer. This too will be analysed – meanwhile the patients will receive further treatment.
And if the cancer comes back after that round of treatment, the patients will again be asked if they will donate tissue samples for further analysis.
And in parallel with all of this – because we now know that signs of cancer DNA can be spotted in the bloodstream – the patients will give blood every three months, which will be stored for analysis at a later date.
As well as tracking patients through time, TRACERx will also bring together expertise through space – in the form of the UK’s enviable network of cancer researchers.
The samples collected throughout the project will be analysed in multiple different ways by different teams around the UK. As well as detailed DNA analysis (of which more below), Dr Sergio Quezada in London and Professor Gary Middleton in Birmingham will look at the involvement of the patient’s immune system in each sample.
And Professor Caroline Dive in Manchester, and Dr Jacqui Shaw in Leicester, will analyse the blood samples for signs of circulating cancer cells or DNA respectively.
All of these researchers are supported by Cancer Research UK. “It’s a pan-CRUK dream protocol,” enthuses Swanton.
But the centrepiece of TRACERx will be the genetic analysis Swanton’s collaborators will be performing.
Rather than analysing the entire 3 billion ‘letters’ of the human genome in each sample, they’ll be using a technique called ‘exome sequencing’, and homing in with precision on the 1.5 per cent of our DNA that encodes our genes – something that wouldn’t have been possible without the human genome project back in the 90s.
But that still amounts to some 51 million ‘letters’ of DNA for each tumour sample.
On top of this, to ensure the results are accurate (after all, one wrong letter is a big deal in genetic terms), they’ll analyse each sample not once, but 500 times over – about 510 million DNA letters in all.
But – uniquely – they won’t just be analysing a single sample. They’ll be analysing six different regions of each patient’s tumour, as well as a sample of their normal tissue for reference. And then even more regions at a later date, if their cancer comes back or spreads.
When you add up the total amount of DNA sequenced for each patient, it amounts to nearly 223 billion letters of DNA.
And they’re doing this for 850 patients.
All in all, TRACERx will be running about 195,075 billion letters of DNA through the DNA sequencing machines at UCL and our London Research Institute, over a nine year period. That’s the equivalent of more than 65,000 human genomes.
No research team has ever looked at lung cancer in this sort of detail before. This is using the map of the human genome to explore completely uncharted territory.
The resulting data will allow Swanton and his collaborators to reconstruct the genetic architecture of each patient’s disease, spotting commonalities and differences, and providing a template for future progress. They’ll be able to answer questions like:
How quickly does genetic variation develop?What processes drive it?How is it related to how patients fare?Can we target variation with drugs?How does treatment affect the development of variation?Are there different ‘types’ of non-small cell lung cancer? (as we’re now finding in breast cancer)Can we predict how a patient’s tumour will behave?What role does the immune system play in the disease? Tracey and Heidi raise money in Ceri’s memoryThe primary aim of TRACERx – which will begin recruiting later this year – is to understand what lung cancer is – how it adapts and responds to treatment, and where its Achilles heels are (since there are sure to be different vulnerabilities in different patients).
At the outset, no patient will receive any different treatments on the study other than what’s routinely offered on the NHS.
But the data generated will help identify patients who could benefit from existing drug trials – particularly of newer, targeted treatments.
Indeed, the study has already gained the attention of several drugs companies, interested in setting up more trials in the UK. TRACERx will provide a valuable resource to identify patients who could benefit from such trials.
Ultimately, this is about cracking open our understanding of a disease for which there’s an urgent need for progress. That’s something Heidi and Tracey can readily identify with.
As someone who takes part in Race for Life, and has even climbed Mount Kilimanjaro to raise money for research in Ceri’s memory, Heidi told us; “Much more urgently needs to be done to improve treatment for people with this disease, and so we really welcome this £14 million investment from Cancer Research UK.
“Cancer doesn’t care who you are or who you might leave behind. Our family has experienced first-hand the devastation that it causes, and things have to change. And it’s only by doing research that we can beat this terrible disease.”
More than a decade after the publication of the first draft of the human genome, the huge promise offered by that scientific breakthrough is now starting to make its way into studies that will bring real benefits to lung cancer patients – and it’s not a moment too soon.
Henry
1 dead, 2 wounded in Irvington shooting
IRVINGTON — No arrests have been made in a triple shooting that left one man dead in Irvington.
The Essex County Prosecutor?s Office says the shooting occurred on Isabella Avenue shortly after 5:30 p.m. Sunday.
Authorities say 35-year-old Raheem Williams of Linden died at a hospital.
A 35-year-old man and a 24-year-old woman were wounded. Their injuries are not believed to be life-threatening.
Officials say it appears this was a targeted shooting.
150 arrested, 105 children saved from prostitution ring
WASHINGTON — The FBI announced Monday the arrests of 150 people and recovery of 105 children involved in child prostitution rings across the country.
The 76-city sweep, conducted in the past three days, represents the largest such law enforcement action focused on children forced into sexual slavery, federal authorities said.
Assistant FBI Director Ron Hosko, head of the bureau's criminal division, said the children ranged from 13 to 17 years old. The youngest of the victims was allegedly being offered up by her father, who also was allegedly involved in videotaping his daughter's sexual encounters.
"We have victims whose new normal is sexual abuse,'' Hosko said. "We are trying to take this crime out of the shadows and put a spotlight on it.''
See the full list of arrests and recoveries on the FBI's website .
In operations involving 230 separate law enforcement agencies, authorities either made arrests or child recoveries from Atlanta to Los Angeles. The weekend action, called Operation Cross Country, also is the latest in a national campaign that has helped recover 2,700 children since 2005.
Hosko said the children, generally recruited from foster care or group homes, were being offered up on Internet sites, at truck stops, casinos and street corners.
In addition to at least one parent, the alleged pimps included individuals acting alone and some with affiliations to organized crime. In many cases, Hosko said, the children "don't see any avenues of escape'' from their handlers.
John Ryan, president and chief executive officer of the National Center for Missing and Exploited Children, called the criminal activity "an escalating threat against America's children.''
Ryan said the law enforcement action "is saving lives.''
The largest number of children ? 12 ? were recovered in San Francisco during the weekend sweep. The most alleged pimps ? 18 ? were arrested in Detroit.
In the Detroit area, where 10 children were recovered, a 17-year-old girl was rescued Saturday night from an Econolodge Hotel, where she was being held against her will and beaten. Police said a separate prostitution arrest yielded information that led police to the hotel.
In Flint, Mich., a 911 call led police to a home where they rescued two 17-year-old girls who were being assaulted and forced into prostitution. Genessee County sheriff?s deputies responded and rushed the girls out of the home. A suspect, whose identity has not yet been released, was arrested.
Criminal charges are expected to be brought both in the state and federal courts and will involve a variety of offenses, including human trafficking and coercion.
"Child prostitution remains a persistent threat to children across America," Hosko said. "This operation serves as a reminder that these abhorrent crimes can happen anywhere and that the FBI remains committed to stopping this cycle of victimization and holding the criminals who profit from this exploitation accountable."
U.S. Sen. Jeff Chiesa (R-N.J.) commended the FBI and other law-enforcement personnel for the recovery of the sexually expolited children and arrests of pimps and other individuals involved.
SEE MORE: In Lakewood brothels, women forced to serve up to 40 clients a day, authorities said
?Human trafficking is a crime that exploits and hurts some of the most vulnerable people in our society, including children. I commend the FBI?s work on Operation Cross Country and their ongoing focus on this problem. Through the combination of arrests, prosecutions, and increased awareness, we can reduce the incidence of human trafficking and put would-be participants in this criminal activity on notice that law enforcement is on alert and perpetrators face severe consequences,? Chiesa said. ?I am especially proud of the role the New Jersey law-enforcement community played in this operation, as well as their continued recognition and efforts to identify and combat this heinous crime. Our police and prosecutors understand the prevalence of this scourge and they recognize the need for an ongoing focus.?
Additional reporting contributed by Michelle Sahn, Asbury Park Press
2 die after being pulled from water off AC
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2 die after being pulled from water off AC
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5 dead, including child, in Pa. helicopter crash
NOXEN, PA. — A helicopter crash in a rugged, wooded area of northeastern Pennsylvania claimed the lives of five people, including one child, officials said Sunday.
The crash happened Saturday night after the pilot told air traffic controllers he was losing altitude, according to the county coroner.
Wyoming County coroner Thomas Kukuchka said the pilot contacted a nearby tower around 10:30 p.m. saying he would attempt to return to another airfield nearby.
?That?s when he went off radar,? Kukuchka said.
Although the names of those on board have not been released, Kukuchka said three men, a woman and a child were on board.
?It appears to be a father and son, a father and daughter and the pilot,? he said.
Kukuchka did not release the ages of the victims. He said his office was trying to reach family members of the deceased in Leesburg, Va., Ellicot City, Md. and Kitnersville, Pa.
The Federal Aviation Administration said the helicopter took off from Greater Binghamton Airport in New York but officials there said it had actually originated at a smaller airfield nearby, Tri Cities Airport in Endicott. A phone message left at Tri Cities Airport was not immediately returned Sunday night.
State police and FAA personnel were still on the scene Sunday evening, according to Trooper Adam Reed, a state police spokesman. Additional details will be released as the investigation progresses, he said.
Although it was not clear if weather played a role in the crash, Kukuchka said there were severe thunderstorms in the area Saturday night. The coroner and police said rough weather contributed to the difficulty of the search; the wreckage was located shortly before 2 p.m. Sunday.
The FAA said the helicopter was bound for Jake Arner Memorial Airport in Lehighton.
The National Transportation Safety Board will lead the investigation, the FAA said.
A day at the races: Updates from Haskell 2013
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Balloon festival showcases handmade crafts
READINGTON — A few artisans showing their handmade and nature-themed work sat nestled between the food vendors, giveaways and novelty items at the three-day 31st annual Quick Chek New Jersey Festival of Ballooning.
With a tent full of handmade wares, Adar O?Hare and Andrew Welsh of Ripple Pottery trekked all the way from Rumney, N.H., for their first balloon festival. The whimsical mushrooms created by potter Brian O?Hare caught the eye of many attendees.
?Brian started doing the mushrooms as a joke in college,? said wife Adar O?Hare. ?He was a ceramics student, and he would make them and leave them in people?s yards. Eventually they tracked him down. So, he started selling them. That was 20 years ago. He?s been making them ever since.?
?He got in trouble and made a profit,? Welsh joked. ?It was an awesome prank, though.?
Adar O?Hare sees a rejuvenation in items made at home.
?There is a renewed focus on handmade items and those made closer to home,? she said. ?People are looking for handmade crafts again rather than mass-produced items.?
While many of Ripple Pottery?s items are useful, such as the mugs, bowls, earring or sponge holders on display, some, like the mushrooms, sold as a trio of small, medium and large, are purely decorative. All are done with Ripple Pottery?s original and unique glaze process.
?This is our own glaze,? Adar O?Hare said. ?We use three different glazes to get variations of colors.?
Branchburg?s Ed Vaeth of Neshanic Valley Beekeepers sees a tie-in to people?s desire to ?go green.? Selling organic local, domestic and international honey, Vaeth said the key is that the honey be raw ? unadulterated and unpasteurized. Also honey is especially good for people with allergies, sore throats and other health issues, as it acts as a soother.
?The nature of the honey itself in its raw form is what helps,? said Vaeth, who has hives in five counties throughout the state. ?It is recommended to take a teaspoon or tablespoon of honey before you go to bed. It should be at room temperature and not in a hot liquid.?
At the balloon festival, attendees could taste the various types of honey, including specialty honeys such as Florida Orange Blossom, Australian Eucalyptus, New Jersey Blueberry and New Jersey Japanese Bamboo. Some of the most popular flavors include New Jersey Wildflower, Central Jersey Mixed, New Jersey Dutch Clover Blossom and New York/New Jersey Golden Blossom, Vaeth said.
In keeping ?green,? Vaeth also prefers glass containers for his jars over plastic.
?It retains the honey?s natural flavor,? he said. ?And we would rather not add to the plastic waste factor.?
Staci Reiser and Bryan Murawski of Neptune started their jewelry business, Earth to Ocean, three years ago after their sea glass collection seemed to need a purpose.
?We would collect it, and the collection grew so big. I had so much of it,? Reiser said. ?I thought, I?ve got to do something with this. I always wanted to do something where I could be more creative, and this seemed to lend itself perfectly.?
?Everything we make comes out of the ocean,? Murawski said. ?The stones, metals and sea glass ? all of that is from the ocean.?
Now the two do about 70 crafts shows a year and show their beach-inspired wire-wrapped jewelry in a few stores up and down the Jersey Shore. This was their second year at the balloon festival.
?We still are at the beach all the time,? Reiser said. ?We practically live at the beach, and now we bring it with us wherever we go.?
The two said customers seem to appreciate the value of a handmade item.
?They also seem impressed when we make a custom piece on site,? Resier said.
One impressed customer was Jessica Webele of Ewing. Admiring the various necklaces, earrings and bracelets, Webele said they were ?simple but elegant.?
?I just love it,? she said. ?They have taken something so natural and organic and made it unique.?
As always, there were things to do and see for all ages. Throughout the day, Al Belmont of Belmont?s Festival of Magic did feats of prestidigitation and amazed children and adults alike. Belmont said that it was a magic show he saw at age 10 that piqued his interest.
?I got to see a great magician, Blackstone,? he said. ?I got up on stage, and he gave me a rabbit. Then he turned that rabbit into a box of candy. I went home and went to the library and got out a book on magic. I didn?t learn how to do that trick from the book. It took me 16 years to learn that trick, but I was hooked.?
Wendy Carnavale of Parlin, Angelina DeRisi, 9, of Broadheadsville, Pa., and Jill Bush of Fort Lee were very impressed with Belmont?s showmanship.
?I like how he turned the dog into a rabbit,? said DeRisi, while Carnavale thought Belmont?s ?Concert of the Rings? was exceptionally well done. Bush appreciated ?his enthusiasm? and how her whole family from grandchildren to her mother enjoyed the show.
Six-year-old Mackenzie Monto of Manville got in on the action and was brought up on stage to ?assist? with a trick.
?I was kinda scared, but I got used to it,? she said. ?But it was fun.?
For her bravery and help, Mackenzie was given a stuffed ?Bob? the dog, named after one of the live animals Belmont features in his show.
Randy Diakunczak of Edison was especially excited for the day?s events to unfold. While this was a first for his family of four (wife Jennifer and 4?-year-old twins Madison and Justin), as a young man, he performed at the festival, opening for the band America about 20 years ago with his band Shiver.
?I wanted to bring my kids to this for the longest time,? said Diakunczak, now a police officer at Kean University. ?I want them to do what I did growing up. This is a very good family event. My grandmother would bring me to this every year. I?ve always loved it, just love the balloons.?
There were a variety of fundraisers happening at the balloon festival as well. The Navy was in full force with four tents set up selling refreshments and drinks. The fundraiser featured active duty sailors volunteering their time to raise funds for junior members to attend the state?s October Navy Ball.
The festival concluded Sunday with a scheduled mass hot-air balloon ascension in the morning, concerts in the afternoon by R5 and Big & Rich, and a final ascension scheduled for the evening.
Barnegat man charged in Manchester ShopRite robbery
MANCHESTER — A Barnegat man was charged with robbery at ShopRite on Route 70 in the township Saturday night, police said.
Thomas Tomlinson, 28, was charged with robbery, assault and theft, said Capt. Lisa Parker of the Manchester Township Police Department. He also faces charges of eluding in Lakehurst. Bail was set at $150,000 with no 10 percent option on the Manchester Township charges and $100,000 with no 10 percent option on the Lakehurst charges.
Tomlinson was taken to Ocean County Jail after not posting bail, Parker said.
Police responded to the ShopRite at 8:33 p.m. Saturday. When they arrived they were told a man had taken an unknown amount of money out of a 59-year-old female cashier?s register, Parker said.
The cashier told police she was getting change from the till for a customer when the suspect emerged out of nowhere and shoved her away from the register, Parker said.
When the cashier attempted to cover the till, the suspect used his shoulder to pin her against the conveyor belt, Parker said. The cashier injured her left hand, but refused medical treatment.
The suspect left the ShopRite and ran into the parking lot after taking the money, Parker said. Witnesses saw the suspect get into a white Subaru wagon and exit the parking lot in an unknown direction.
After the incident, Lakehurst police saw a white Subaru wagon in the parking lot of Circle Plaza off Route 70, Parker said. When police approached the car, the suspect put the car in reverse and began to pull out of the parking space. Police ordered the suspect to stop, but he ignored them and sped out of the parking lot, Parker said.
Lakehurst police were able to get the license plate number of the Subaru and trace it to Tomlinson, Parker said.
At 6:45 a.m. Sunday morning, and off-duty Manchester police officer saw the white Subaru in the Wawa parking lot at the intersection of Lighthouse and Bay Avenue in Barnegat, Parker said.
The police officer confirmed the license plate number and called Barnegat police for assistance. The driver of the white Subaru was then taken into custody without incident, Parker said.
Manchester police are continuing to investigate the incident. The Ocean County Sheriff?s Department Criminal Investigative Unit and the Manchester Township First Aid squad assisted at the scene.
The Asbury Park Press asked the Manchester police department for a photo of the suspect, but it declined. State law allows authorities discretion in releasing suspect photos, but they often refuse to do so, saying they are prohibited by the county Prosecutor?s Office.
Billing tiff could hold clue to prosecutor's death
WOODLAND PARK — It may have been Jay Fahy?s last secret.
Nearly two weeks before the former Bergen County and federal prosecutor committed suicide, a staff member in his law office inadvertently opened a letter addressed to Fahy, marked personal and confidential.
It was a shocker: The New Jersey Supreme Court was about to temporarily suspend his license to practice law because of a billing dispute.
His law partner tried repeatedly to contact him, but received no reply. And Fahy stopped coming to the office ? except for one late-night visit, after everyone had left, when he dropped off some papers and removed mail from a chair, said Joe Orlando, a longtime friend who is acting as a spokesman for both the family and the firm.
The contents of that letter, and Fahy?s uncharacteristically evasive response to it, may offer the clearest clue to date of why Fahy ? a normally ebullient personality who was cracking jokes with friends up until the end ? shot himself on a Route 17 walkway on the afternoon of July 17.
?Given the timing of the suspension, as well as the value he placed on his reputation, one could easily tie the two together as potential cause and effect for his passing,? Orlando told The Record of Woodland Park. ?But there is no way for us to ever be absolutely certain.?
Fahy?s final choices stood in such jarring contrast to the rest of his life that dozens of people who knew him ? including his closest friends and acquaintances from a long and high-profile career ? have spent the week and a half since his death trying to make sense of it.
Fahy, 58, shot himself just before rush hour on one of the busiest highways in the region, causing traffic to back up for hours in every direction. The public nature of his death inspired speculation that he must have been trying to send some kind of message.
But no suicide note has been found, authorities have said, and no one has come forward with anything but praise for a man who seemed to have been almost universally admired.
It is only through some of Fahy?s last actions that his closest friends have started to piece together a picture of what might have happened. What they have come up with is an unsatisfying and untidy story that raises more questions than it answers.
2011 complaint
When the court issued its ruling, the billing disagreement had been festering since Fahy?s client filed a complaint in 2011. Many of the details ? including how much money was involved ? are still unclear. Unlike formal complaints alleging unethical conduct by lawyers, reviews of fee disputes are confidential under Supreme Court rules.
But the ruling did note that Fahy had failed to comply with the findings of a fee arbitration committee, prompting the court?s Disciplinary Review Board to recommend a $500 fine and temporary license suspension. It also said that penalty would be ?vacated automatically? if Fahy satisfied ?all obligations under this order.?
The order was dated June 28 and Fahy apparently opened an email from the court on June 29, Orlando said. But he never told his colleagues about it.
The billing complaint came from onetime Fort Lee real estate broker Jamila Davis, according to her mother. Davis ? sentenced in 2007 to 12? years for fraud, according to federal court papers ? was trying relentlessly to reopen her case when she hired Fahy.
Davis was in her late 20s when she was arrested. She?d dated NFL players, socialized with hip-hop stars and sold multimillion-dollar homes in Alpine and Upper Saddle River, according to her former attorney, Thomas Nooter. Federal officials later said the houses were sold to straw buyers and that their purchase prices were greatly inflated on loan applications submitted by Davis and her co-defendants.
She never thought of herself as a criminal, Nooter said.
?She probably realized she was pushing the envelope,? Nooter said. ?That?s what she probably thought she was doing. Everyone else thought what she was doing was fraud.?
It is unclear what Davis asked Fahy to do. His name is not on any of the official court documents filed with her case. But Nooter said he suspected Fahy wrote a motion arguing to reopen the case that was filed under her own name.
?I think Jay wrote it,? he said. ?I don?t know that he wrote it, but it looks like he did.?
Davis is in a low-security prison in Danbury, Conn., and could not be reached for comment last week. But her mother, Liddie, said the family thought Fahy had not done the work they had paid him for, and that Fahy could not produce any documents to back up his bills.
?We paid money out of our pensions and we didn?t get it back,? she said. ?It wasn?t fair.?
She declined to say how much money the court ordered him to return to the family. But she does not believe it was enough to explain his death.
?It wasn?t that much money, for a rich man like that,? she said.
She said the court had called several times to see if Fahy had repaid them. She said he never did.
Lived by moral code
Fahy?s friends believe he would have been more troubled by the perceived blow to his reputation than by the money involved.
He was not the type to drop cash on lavish trips or $2,000 suits, his friends said. Besides a nice home in Rutherford, he lived modestly. He paid $9 to cut the shaggy silver hair that became one of his calling cards on cable television, where he frequently appeared as a legal expert discussing cases including the George Zimmerman trial and convicted child molester Jerry Sandusky.
Those who knew him say Fahy also lived by a strict moral code.
?It?s not the money. It?s the indignity he made himself feel,? said Frank Migliorino, a friend and attorney in Little Ferry. ?When other lawyers see a case like this, they say, ?There but for the grace of God go I.??
Fahy worked for 30 years to build his reputation, ever since he was a rising star in the Hudson County Prosecutor?s Office in the 1980s. From there he became an assistant U.S. attorney, Bergen County prosecutor, then a defense attorney with a successful private practice in Rutherford with his partner, Benjamin Choi.
Throughout a career in which he brought major cases against corrupt police officers and politicians, Fahy was always upbeat, but he could empathize with others, his friends said.
?He had almost a puppy-dog sadness. He was hangdog sometimes,? Migliorino said. ?He had a sense of innocence, like an altar boy grown up.?
Three weeks before Fahy committed suicide, he and Migliorino discussed a small case involving The Balcony, a bar in Carlstadt that had received noise complaints from neighbors. As the borough?s attorney, Fahy was trying to reach a compromise with Migliorino, who represented the bar.
?He looked sad because he understood what the neighbors were going through,? Migliorino said. ?Even the more mundane things, he took seriously. He internalized it.?
For some attorneys, losing a fee dispute causes great emotional distress. Patrick Caserta, an attorney in Wayne, is a former chairman of the District 11 Fee Arbitration Committee, which covers Passaic County, and has represented other lawyers in such disputes. Some of Caserta?s clients took such proceedings in stride while others believed ? incorrectly ? that their careers were over.
?Some lawyers can feel it is some sort of black mark on their career,? said Caserta, speaking about such cases in general. ?In my experience, it is not at all uncommon to see someone become unraveled by what others might see as a minor dispute and a routine part of their practice.?
The man who literally wrote the book on attorney fee disputes, Robert Ramsey, has been involved in 10 of them.
?It?s the most routine thing you can imagine,? said Ramsey, author of ?New Jersey Attorney Discipline,? the textbook lawyers refer to when handling disciplinary matters. But a failure to resolve such a dispute before a suspension takes hold is unusual, he said.
Had Fahy chosen to share his trouble with his friends, they say, they could have helped.
?If Fahy came up to me and said he needed $10,000, I?d give it to him,? Migliorino said. ?It almost makes me angry that he didn?t give us a chance. We could have helped him.?
Missed meetings
But Fahy didn?t say anything to the friends he saw during his last days.
He missed the first two July meetings of the Carlstadt Borough Council, said Borough Clerk Claire Foy, and called Mayor William Roseman before the July 15 meeting to ask if it would be OK to miss the third.
?I told him to stay in bed and get some rest,? Roseman said. ?He said he really wasn?t feeling well, and naturally he sounded like he didn?t feel well. Not like he was depressed, just not well.?
The week before Fahy shot himself, he stood on the second floor of the courthouse in Lyndhurst and talked with friends about John Frank, a former police chief in Wood-Ridge who continued working as the Bergen County Police Department?s director of security even as he suffered through chemotherapy. Frank died of cancer July 3.
?Jay was talking about John Frank?s courage, how he fought cancer so long and went to his job every day,? said Migliorino, who was there. ?That was the word Jay himself used: courageous.?
That same week, Fahy ran into Raymond Flood, a Hackensack lawyer, in the Bergen County Courthouse. They discussed a case they were working together. As usual, Fahy was dressed in a business suit, and nothing seemed out of place.
?There was nothing that I saw that in any way indicated he was having any problems,? Flood said.
Fahy even agreed to take on a new client in his last days. It was a favor to his friend, Orlando.
Orlando said the two spoke by phone on July 13. Fahy, in typical fashion, was cracking jokes.
They spoke again on July 16, when Fahy confirmed that he would meet his new client the following afternoon.
?He said he was going to be at a meeting at 3, he said he would take care of it,? Orlando recalled.
Fahy never showed up. Two hours later, he was dead.
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