29 Apr 2014

From death sentence to survival: what has been cured?

Would you choose cancer or dementia? As a new study finds cancer survival rates are improving, Channel 4 News looks at the diseases that are no longer a death sentence – and the diagnoses we now fear.

Cancer is a big word, heavy with meaning. It is also the subject of many a “battle”: patients “fight” it or “beat” it, unless they are, tragically, “defeated”.

In a moving personal piece about his diagnosis, Swedish writer Henning Mankell, author of the Kurt Wallander novels, wrote: “I am a child of the 1940s. I think that everybody of my generation automatically associates cancer with death.”

But a new study has found that we are beginning to “win the war” against some cancers. En masse, half of those just diagnosed with cancer in the UK can now expect to live for another 10 years. Britain is still lagging behind western Europe, but it is a huge improvement since the 1970s, when average survival rates were just one year from diagnosis.

Testicular cancer patients fare the best, with 98 per cent surviving at least a decade, along with 89 per cent of those with malignant melanoma. For breast cancer sufferers, 78 per cent survive for at least a decade, compared to just 40 per cent in the 1970s. The outlook remains bleak for the deadliest cancers, including lung, oesophagus, pancreas and brain.

Time to ‘shift the narrative’

The study by the London School of Hygiene and Tropical Medicine’s cancer survival group shows just how far we have come. And it has prompted Cancer Research UK, which announced the findings, to call for a new way of thinking about cancer: physchologically and in terms of treatment. The current yardstick for progress is whether patients remain cancer-free for five years.

“With the progress that’s been made over the last few decades we think it’s time now to shift the narrative and to change the language we use and start thinking about 10-year survival from cancer,” said Dr Cancer Research UK Chief Executive Harpal Kumar.

People know they’re probably going to have a finger up their bum, and they’re reluctant to come forward. Dr Will Murdoch

“The mix of cancers has also changed,” Manuela Quaresma from London School of Hygiene and Tropical Medicine told Channel 4 News. “Lung cancer has become much less common, particularly among men, while breast cancer, mainly among women, has become much more common.”

As well as improvements in treatment, experts have largely put the good news down to earlier, and quicker diagnosis. With its two week wait service, the NHS now guarantees that patients who meet the criteria will be screened for cancer within a fortnight and will get the results of their test soon after.

Read more: Science Editor Tom Clarke on cancer survival rates

HIV: from killer to ‘cure’

The emphasis on early diagnosis is crucial for the treatment of many previously fatal diseases. Take HIV: people were dying of Aids right up until the late 1990s. In 2014, the vast majority of sufferers can manage an HIV infection with a daily dose of antiretrovirals (ARVs) without it ever leading to Aids.

While the immune system of sufferers is more vulnerable, the vast majority have a similar life expectancy to non-sufferers. Treatment is even available to stop pregnant women passing the disease on to their children.

“HIV/Aids wards and specialist units have closed simply because there is no longer the volume of patients to fill them,” Dr Max Pemberton wrote in the Spectator earlier this month. “This is a hugely encouraging fact, which would have seemed impossible to those who stood, in the 1980s and 1990s, as friends, family and loved ones faded away while doctors stood by utterly helpless. What is truly startling is the speed with which medicine responded to HIV.”

Vaccination nation

For those under 30, it is easy to forget the huge impact of vaccinations on chronic or fatal diseases. Before the MMR vaccine was introduced in 1988, around one in five children suffered from complications after measles, and the disease spread very quickly. Pneumococcal infections – which can lead to pneumonia, septicaemia and meningitis in children – also used to be fairly common among children, before the “pneumo jab” was given to under 2s.

With the progress that’s been made (in cancer) over the last few decades we think it’s time now to shift the narrative Harpal Kumar

Another disease that looms large in our past is hepatitis, or liver inflammation, which can infect and lead to liver damage. “That was the HIV of the 70s and 80s. That used to be a disastrous diagnosis,” Dr Will Murdoch, a Birmingham GP, told Channel 4 News. “Now people hardly bat an eyelid about it.”

Standardised vaccination for hepatitis A and B in very young children has immunised just under 100 per cent of people from chronic liver damage. Some forms of hepatitis can be caused by alcohol or drugs.

Hepatitis C, which is most commonly spread through sharing needles to inject drugs, is more common and can lead to serious complications. However even chronic forms can be treated with antiviral medicines if caught early enough. Earlier this month, a study had huge success with a treatment that cured 90 per cent of patients in just 12 weeks.

Read more: What is dementia? The key questions

What to fear in 2014

So what diseases or conditions are most feared in 2014? It seems an unlikely menace, but dementia is where the government is putting its money – and muscle. David Cameron has pledged to double funding for dementia research from £66m in 2015 to £122m in 2025. It is still well below the £267m for cancer, but it is a sign of the concern among professionals and policy makers about the illnesses affecting an ageing population.

Dr Murdoch agrees, and said it is one of the main areas where there has not been much progress: “It’s a really difficult area… to be eligible for many drug trials, you have to have a low memory score anyway. And if that’s gone up slightly, what does that really mean for your lifestyle?”

And while the London School of Hygiene and Tropical Medicine’s study spelled good news for many cancers, there are many where survival rates are far too low. And they tend to be those which are hard to detect or those with vague, or embarrassing, symptoms.

One of the main offenders here is bowel cancer, which until recently, was kept below the radar. “While the Brits are obsessed with their bowel action, when they start to see abnormalities, the stiff upper lip comes out,” Dr Murdoch told Channel 4 News. “People know they’re probably going to have a finger up their bum, and their reluctant to come forward.”