News from Around the Globe

Research is constant.  Every day we are learning more about how to fight cancer in all of its forms.  Here are the latest news articles from some of the leading cancer organizations.  Check back often to stay up to date.

news from around the world

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Stronger Than Cancer has shared these news articles for information purposes only.  It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

 

Amla (dried Indian gooseberry) vs. Lipitor for Lowering Cholesterol

2 hours 8 minutes ago
Extracts of amla (Indian gooseberry) were pitted head-to-head against cholesterol-lowering statin drugs and the blood thinners aspirin and Plavix. Indian gooseberries, otherwise known as amla, […]

Research shows one size doesn’t fit all for cervical screening in the trans and non-binary community

11 hours 2 minutes ago

Science blog

The soft thud as once every few years a cervical screening invite lands on the doormat.

A gentle reminder to book a cervical screening appointment, should it be wanted. But for transgender men or non-binary people assigned female at birth, this invite may not be automatic and getting access to this service can be much more difficult at every step of the way.

“LGBTQ+ people in general, and particularly trans people face a lot of inequalities with regards to their health,” says Dr Alison May Berner, a cancer specialist at the Cancer Research UK Barts Centre and part time registrar in adult gender identity.

According to a report put together by Stonewall, a quarter of LGBT people have faced a lack of understanding for their specific health needs by healthcare staff, which rises dramatically to more than 3 in 5 for trans people. And 1 in 6 (16 %) trans people said they have been refused healthcare because of being LGBT.

Berner has spent the past three years working with LGBTQ+ communities to understand why such startling inequalities exist.

“There’s more we can do to try to work with the LGBTQ+ population to identify why some of these inequalities are occurring and level the playing field, doing that in a way that’s acceptable to trans and non-binary people, not putting something upon them.”

The importance of the cervical screening programme

An area of concern for Berner and the team is cervical screening, which can help prevent cervical cancer from developing and saves thousands of lives each year in the UK. But not everyone has equal access to this service.

Cervical screening is for everyone with a cervix

Not all trans men or non-binary people assigned female at birth have surgery to remove the cervix. For those that don’t, the NHS recommends they undertake cervical cancer screening with the same frequency as cisgender women. But we know there are many barriers to this, and they face many inequalities in accessing care.

Every year just under 5.4 million people are invited to cervical screening in the UK, with invites based on GP records (data from England, Scotland, Wales and Northern Ireland). Of these, around 72% take up the invite. However, there is no overall data of how many trans men and non-binary people are eligible for and attend screening.

Stewart O’Callaghan is the founder and executive director of Live Through This, a charity that supports and advocates for LGBTIQ+ people affected by cancer. “Trans and non-binary patients seeking cervical screening face numerous barriers ranging from not receiving an invite due to the NHS not recording a person’s transgender status on their patient record, to samples being refused from the lab if samples are marked as male. It is important trans patients’ experience of screening is as straight forward as their cisgender peers,” they say.

What do the terms cisgender and transgender mean?

Those who identify with the gender they were assigned at birth, usually a decision made by a doctor based on physical characteristics, are referred to as cisgender. For transgender people, their identity and innate knowledge of who they are is different to their gender assigned at birth.

Trans, or transgender are broad terms that can mean different things for different people. A trans woman is a woman but was thought to be male when she was born. Likewise, a trans man is a man, but was thought to be female when he was born. Lots of people don’t identify as either a man or a woman and might describe themselves with another identity, such as non-binary.

There’s no one ‘right’ way to be trans. Trans people do not have to dress or act a certain way to conform to societal norms and, though it is really important for some trans people, they don’t need to have medical treatment to change their physical appearance unless they want to. The experience of trans and non-binary people is varied, and the best way to understand what being trans is like is to seek out authentic stories told by transgender people.

Berner wanted to know more, so decided to undertake research asking trans men and non-binary people directly about their experiences of cervical screening. Believing passionately that “there needs to be more investment into research for trans health. Not focusing just on how we deliver gender affirming care, such as hormones and surgeries, but how can we best safeguard the rest of a trans person’s health.”

Trans men and non-binary people’s attitudes to cervical screening

“I thought about the need for this research towards the end of 2017, realising this was an area of unmet need. And at the same time Jo’s Trust were also coming to the same conclusion,” recalls Berner.

“We all agreed if we were going to produce the best information for trans and non-binary people and improve the field, we needed more than a casual survey, we needed a robust research study.”

Results from the study were published today in the British Journal of General Practice.

Berner and the team asked 140 trans men and non-binary people to share their past experiences and attitudes towards cervical screening.

“The study showed having a male gender marker on healthcare records, meaning patients aren’t automatically called and reminded for screening makes it less likely that someone will make their cervical screening appointment,” explains Berner.

“The experienced or anticipated stigma, as well as discrimination from health care professionals which, unfortunately, still continues, even though it’s reducing, is also distressing enough to act as a barrier to seeking care.”

Berner adds that a poor understanding of trans health by the healthcare provider, or the fact GPs or nurses may not have had good training in how to approach cervical screening in this population, can also present problems.

“There is a lack of understanding around the broader context of what trans men and non-binary people might have been through as part of their transition, or how to use the correct pronouns or terminology, which is incredibly off putting for patients.”

“If an invitation lands on your doormat, saying, dear Miss Jones and you’re in fact, Mr Jones, you’re not really going to want to visit that service.”

On top of this, people reported seeing mainly female-centred information materials, leaving recipients not wanting to engage with materials they didn’t feel were inclusive of them.

“These barriers can be incredibly damaging. As well as making trans and non-binary people less likely to attend screening, they can also trigger gender dysphoria,” says Berner. This is a sense of unease or distress a person may have because of a mismatch between their biological sex and their gender identity.

https://scienceblog.cancerresearchuk.org/wp-content/uploads/2021/01/Q2-dysphoria.mp3

“Continually hearing words referring to the female anatomy, or hearing the word ‘women’, that’s going to be quite off putting, if that’s not how you identify. And that dysphoria might also come from the screening procedure, because it’s engaging with a part of the body that’s thought of as female.”

What could improve access to cervical screening?

Berner’s work highlights barriers faced by the trans and non-binary community that many people perhaps hadn’t ever considered. And yet most can be overcome through education of healthcare providers, greater awareness of gender terminology and the provision of tailored services.

One such service is the No Barriers Cervical Screening Project, which operates at 56 Dean Street in London.

Another, Clinic-T, is run by Dr Kate Nambiar in Brighton, “As a clinician who does cervical screening for trans patients, I see the worry people have about how they will be treated. For many trans people, because the test is invasive and can trigger dysphoria, they simply avoid getting it done. Yet there are many things as clinicians we can do to reduce the discomfort, putting in place simple interventions. That’s not to say these things can’t also be done at non-specialist services – in most cases, a little education in the needs of the trans and non-binary population can go a very long way.”

Berner’s research backs this up, finding that trans men and non-binary people were more likely to go for cervical screening when their non-specialist healthcare providers educated themselves to be more accommodating.

Berner says, “the best way to facilitate screening and overcome these barriers are specialist services that offer a tailored approach. Whether it be scheduling additional appointment time, using muscle relaxants to help with the process or knowing how to correctly gender someone – using the right pronouns and making people feel welcome and at ease.

“Improving information materials to make them more inclusive or targeted for trans and non-binary people could also help increase screening uptake. And the option to self-sample for HPV. Self-sampling is being piloted in the UK and has been successful in other countries including the US.”

For Berner, the major finding is we shouldn’t do screening as a one size fits all. “We need to think carefully about what different types of information people might need, it may be gender neutral information or bespoke information.”

https://scienceblog.cancerresearchuk.org/wp-content/uploads/2021/01/q2-bespoke.mp3

“There needs to be the ability to opt in or opt out. Inviting people in a way that is acceptable to them. And providing them with a service that makes them feel comfortable…”

Berner also believes the service needs to rethink how it invites people so that everyone is free to make an informed choice about screening. “Not everybody will feel comfortable with a call and recall, but some people want it, and there needs to be the option to receive a cervical screening invite even if they have a male gender marker. There needs to be the ability to opt in or opt out. Inviting people in a way that is acceptable to them. And providing them with a service that makes them feel comfortable.”

Above all, Berner believes that a bespoke attitude to screening could benefit everyone, a conclusion echoed in Sir Mike Richards’ screening review. “If a cis woman has had a traumatic hysterectomy, she may want to opt out of receiving cervical screening reminders. So, let’s do away with a one size fits all approach and provide the best care we can for everyone’s individual needs.”

Angs is a health media officer at Cancer Research UK

As a result of this study Jo’s Trust have produced some resources about cervical screening for the trans and non-binary community. You can also find out more about cervical, bowel and breast screening for transgender and non-binary people on our website.

Reference

Alison May Berner, et al. (2021) Attitudes of Trans Men and Non-binary People to UK Cervical Screening. BJGP. DOI: https://doi.org/10.3399/BJGP.2020.0905

The post Research shows one size doesn’t fit all for cervical screening in the trans and non-binary community first appeared on Cancer Research UK - Science blog.

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The Most Antioxidant-Packed Whole Food

5 days 2 hours ago
Are the apparently amazing benefits of amla—dried Indian gooseberries—too good to be true? In reference to amla, also known as the Indian gooseberry, it’s been […]

Ovarian cancer screening trial did not save lives

5 days 11 hours ago

Science blog

“The effort from the start was to save lives of women with ovarian cancer. To build evidence for a screening programme that the NHS could introduce. To have an impact on the lives of thousands of women who are affected by ovarian cancer each year.”

Professor Usha Menon, a gynaecologist at University College London, has been working to improve ovarian cancer diagnosis since the mid-90s. Specifically, she’s worked to pick up ovarian cancers earlier, when treatment is more likely to be successful.

The benefits of earlier diagnosis are clear – around 90 in 100 women diagnosed with early-stage ovarian cancer survive for 5 years or more, compared with just 3 in 100 women with late-stage disease.

But spotting ovarian cancer early enough to make a difference is difficult. Symptoms can be vague and are usually shared with other, more common, and often less serious, conditions.

To try and make the shift needed, Menon and others looked to screening.

In 1999, Menon joined Professor Ian Jacobs’ team and together they set up the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS).

20 years later, the results are in.

Putting ovarian screening to the test

In the 80s and 90s, researchers were hunting for tests that could pick up ovarian cancer earlier.

Two strategies seemed to hold promise – one based on ultrasound and the other looking at changes in the levels of a protein called CA125 in the blood. Jacobs and Menon selected these to put to the test in a large, randomised control trial.

Alongside other organisations, our forerunners funded UKCTOCS. The goal – to prove if either approach could save lives from ovarian cancer.

The trial involved 202,000 women aged 50 to 74 across the country:

  • Half the women formed the ‘control’ group and weren’t given any screening.
  • A second group were given a yearly ultrasound scan to look for abnormalities in the ovaries that could be a sign of cancer.
  • A third group were given an annual blood test to measure their CA125 levels.

CA125 levels are often raised in women with ovarian cancer. But as levels can vary between women, the team developed a more sophisticated approach, measuring how each woman’s CA125 levels change over time. They called the approach the ‘Risk of Ovarian Cancer Algorithm’ (or ROCA, for short).

After each blood test, ROCA generated a risk-related score that would affect what happened next:

  • Women with ‘normal’ ROCA scores continued with annual screening.
  • Those at ‘intermediate risk’ had another blood test 3 months later.
  • Those at ‘elevated risk’ had another blood test and an ultrasound within 6 weeks.

The ROCA test is now available privately. Several of those running the trial – along with Cancer Research UK (via our technology transfer company, Cancer Research Technology) – receive a proportion of proceeds from its sale.

The trial recruited women from 2001 to 2005, with yearly screening continuing until 2011. Then it was a waiting game.

It takes a long time to determine whether screening affects deaths from the disease, so the researchers had to follow the participants up until 2020 to be sure if there was the impact or not.


Copy this link and share our graphic. Credit: Cancer Research UK

What did UKCTOCS find?

The ultrasound screening strategy wasn’t able to detect ovarian cancers earlier or save lives.

However, data from the blood test group was more interesting.

“What we found is with the strategy that used the blood test, we did pick up women with ovarian cancer earlier than in the control group where women had no screening. But in both screening groups we were not able to save lives.”

In the blood test group, the incidence of early stage (1 or 2) ovarian cancer was 39% higher than in the no screening group which is a promising indicator. But this isn’t enough to show the benefit of screening – the balance of a range of benefits and harms must be taken into account.

The most important target for a screening strategy is reducing deaths from the disease. And unfortunately, this goal was not met.

For Menon and the team, the results were deeply disappointing. Menon thinks there are a few reasons that despite promising signs, the CA125 blood test strategy didn’t ultimately save lives. “We didn’t pick up enough women early and we didn’t pick up cancers early enough.”

The team also noticed that women who were picked up earlier didn’t seem to respond to the standard treatment as expected. They’re looking at this data in more detail now.

“What we need to do now is to analyse very carefully what treatment people on the trial received. And there are a lot of insights that I think the trial can provide.”

An enduring legacy

All women who took part donated their data and blood samples for researchers to use in secondary studies. And in the group 50,000 women who had yearly blood tests, this has created an extremely rich resource. “What we have is a very unique set of annual samples spanning 7 to 11 plus years,” says Menon.

The team look forward to “using and sharing the data and the samples with researchers the world over. So that we don’t leave any stone unturned and we learn everything we can.”

For the women who were diagnosed with ovarian cancer during the study, these blood tests offer a snapshot into what was happening in the years leading up to diagnosis.

Menon says these samples are already being used to evaluate promising new tests coming through. “We have the ability to use this bank and the earlier samples to see if new tests could have performed better than CA125 and ROCA.” This data will be invaluable in guiding future trials.

The data also provide a unique opportunity to study how ovarian cancer develops, something Menon is keen to explore further. “We’re hoping that people who do natural history modelling will use this data to try and understand more about ovarian cancer.”

This knowledge could lay the groundwork for new approaches. Because as Menon points out “all our attempts for early detection are based on understanding the disease better”.

And it doesn’t stop with ovarian cancer.

Beyond ovarian cancer

“There were also women who took part who were diagnosed with other cancers – breast cancer, bowel cancer – as well as other diseases. And because they were willing to share their data and samples with researchers, we also have lots of groups who are working on early detection of other cancers using the UKCTOCS samples.”

These samples are a crucial part of the legacy of UKCTOCS, which will help guide future studies. “It’s a very rich resource for which we are hugely grateful to the women for sharing with the wider world.”

Menon says another legacy of the trial is to reaffirm how important it is to look at lives saved in big screening programmes.

“If we had just focused on early detection and what percentage of women are diagnosed at stage 1 or 2, we might have got the wrong answer. That’s why we followed everybody for so long – we needed to find out if diagnosing women earlier will translate into lives saved, but it didn’t.”

The road ahead

While the trial involved many from what Menon calls the ovarian cancer community, it’s not been the only focus for the community.

“There’s a lot of efforts focused on symptomatic women – trying to decrease diagnosis at advanced stage and the number of women diagnosed through A&E.”

There have also been many improvements in ovarian cancer treatment in the last decade.

Spotting ovarian cancer

Symptoms of ovarian cancer can be quite vague and similar to symptoms caused by less serious conditions, which can make spotting the disease tricky. If you notice unusual or persistent changes, talk to your doctor.

Whether it’s needing to go to the toilet more often, pain, bloating, or something else, raise it with your GP – in most cases it won’t be cancer but it’s best to get it checked out.

Researchers are also looking into better risk management strategies for high-risk women.

“In UKCTOCS, we tested screening in the general population. But there’s a small group who are at an increased risk of ovarian cancer because they have a genetic mutation.” For these women, studies are exploring how to refine risk reducing surgery, as well as more frequent screening.

It’s been a long road for Menon and the UKCTOCS team and they’re not done yet. Looking back on the last two decades, Menon says the team are indebted to the women who took part and to everyone who supported the trial.

“I think we can be proud of the effort – it was a huge trial spanning 20 years. Everyone came together and supported it. It’s a testament to the research that can be done in the NHS.”

Katie

The post Ovarian cancer screening trial did not save lives first appeared on Cancer Research UK - Science blog.

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‘Will cancer make me infertile?’ – That Cancer Conversation

6 days 2 hours ago

Science blog

For the first episode of our new podcast, we explore cancer and infertility.

The post ‘Will cancer make me infertile?’ – That Cancer Conversation first appeared on Cancer Research UK - Science blog.

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Elections 2021: What the results mean for people with cancer

6 days 21 hours ago

Science blog

On Thursday 6 May, voters turned out to decide who would form the next Scottish and Welsh Governments, as well as who would take on the mayoralties of 8 city regions in England. Voters in England also voted in 143 local council elections.

It was a big day for many reasons – determining who’s responsible for the NHS in Scotland and Wales, including COVID-19 recovery plans, and setting the direction of travel for the next 5 years in each nation or region.

Before the elections, we sought to influence the political party manifestos to include key commitments on cancer.

And during the election period, our Campaigns Ambassadors and e-campaigners sent thousands of messages to candidates, explaining why #CancerWontWait, particularly as health services recover from the pandemic and transform to improve outcomes.

So, with the results now clear, what do these elections mean for people affected by cancer?

Scotland

With a record turnout, the Scottish Parliament elections saw the SNP again returned as the biggest party. While they were just short of a majority, it’s expected that the party will govern with support from the Scottish Greens.

In the run-up to the election, the SNP launched their manifesto with some key promises on health and cancer, including:

  • Increasing funding by £2.5bn in the NHS
  • Implementing the NHS recovery plan
  • Introducing a law to restrict price promotions on food and drink high in fat, sugar and salt
  • Publishing a new tobacco control strategy
  • Setting up fast track cancer diagnostic centres in every health board and investing an additional £20m in the Detect Cancer Early programme

We saw similar commitments in the manifestos of other political parties, meaning that there should be cross-party support for many of the measures needed to improve outcomes for people with cancer.

The election resulted in around a third of all MSPs being new to the Scottish Parliament (42 out of 129). Over the coming weeks, we’ll be speaking to as many as we can to continue building support for action on cancer.

One of our top priorities for the new Scottish Government will be the new legislation to restrict price promotions on the unhealthiest food and drink, to help tackle obesity and prevent cancer. This is something we have campaigned for some time through our Scale Down Cancer campaign and we are calling for this to be included in the Programme for Government, expected soon.

Wales

Welsh Labour matched their previous best result at a Welsh Parliament/Senedd Cymru election, winning exactly half of the 60 available seats. With this outcome, it is likely that Labour will continue to govern in Wales, seeking support from other parties on a case-by-case basis.

While the Welsh Labour manifesto did not contain any specific cancer commitments, there were several promises on the NHS, which we’re keen to see enacted:

Providing funding to the NHS for recovery from the pandemic, including on delayed treatments.

Training 12,000 new doctors, nurses, allied health professionals and psychologists.

Changing the way NHS Wales is government by introducing a new National Executive.

Before the election, the Welsh Labour Government published its Quality Statement on Cancer to replace the Cancer Delivery Plan 2016. At the time, we opposed this – as did many other cancer charities – for lacking detail and ambition.

Our priority for the new Welsh Government will be to change its approach and develop a comprehensive cancer plan that will improve cancer survival in Wales. As this was a promise in both the Welsh Conservative and Plaid Cymru manifestos, we’ll be seeking support from across the Senedd, including the 18 new MSs.

England – Metro Mayors

Alongside parliamentary by-elections and local elections, votes were cast to decide the new Metro Mayors for England’s 8 city regions – Cambridgeshire & Peterborough, Greater Manchester, London, Liverpool, Tees Valley, West of England, West Midlands, and West Yorkshire.

The final results led to 6 Labour Mayors – including 2 changes from the Conservatives and the first Mayor of West Yorkshire – and 2 Conservative Mayors.

The remit of each Metro Mayor is different, with only one, Greater Manchester, having direct responsibility for health and social care in their region. While that means they might have less direct opportunity to improve cancer diagnosis, treatment and survival, they are still important players.

They are leaders in their community and hold a lot of influence, both locally and with national bodies. As a result, they can be important champions for people affected by cancer.

One of the key themes found across a number of the mayoral races was the need to tackle health inequalities. This is vital – with figures suggesting that there are around 20,000 extra cancer cases each year in more deprived areas of the UK and that rates of smoking related cancers 3 times higher for the most deprived populations compared to the least deprived.

Metro Mayors can play a key role in this space. We will look to work with each of them on this shared objective during their terms in office.

The elections also gives us an excellent chance to grow our Councillor Cancer Champions network, inviting new and returning councillors to take local action on cancer.

What’s next?

For us, the election results are the starting gun for our work to begin. With new governments and mayors in place, we will campaign tirelessly to bring about the changes urgently needed by people affected by cancer.

But we cannot do it without your help. People like you helped make cancer a key issue during the election. Now we need to keep up the momentum to ensure change happens.

Help us keep the momentum: Sign up to campaign with us

The post Elections 2021: What the results mean for people with cancer first appeared on Cancer Research UK - Science blog.

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Presumed Safety of Probiotics Questioned

1 week ago
In certain medical conditions, probiotic supplements may actually make things worse. If you’ve ever made sauerkraut at home, you know you don’t have to add […]