30 years of cancer research in Ireland – 30 years of giving hope

From novel treatments to new ways to prevent and detect cancers, the impact of cancer research has seen more Irish people survive the disease than ever before.

In 1997, 4 in 10 Irish cancer patients were alive 5 years after their diagnosis.

Today, that figure is 6 in 10, thanks in large part to huge strides in cancer research that have improved our knowledge of how cancer is prevented, how we can detect it earlier (when it is often readily cured), how we can treat it better, and how we can make sure people live longer, better quality lives after their cancer diagnosis.

Since Daffodil Day began 30 years ago, cancer research in Ireland has benefitted hugely from the support of the Irish public. The public’s donations have meant that the Irish Cancer Society has been able to invest in vital research being carried out by some of the country’s best scientists and doctors.

As a result, the Irish Cancer Society is the leading non-state funder of cancer research in Ireland. Since 2010 we’ve invested €20 million in cancer research, all coming from public donations. Daffodil Day keeps cancer research in Ireland at world-class standard, because the public’s generosity allows us to invest in the best.

[[{"fid":"6811","view_mode":"preview","fields":{"format":"preview","field_file_image_alt_text[und][0][value]":false,"field_file_image_title_text[und][0][value]":false},"type":"media","field_deltas":{"1":{"format":"preview","field_file_image_alt_text[und][0][value]":false,"field_file_image_title_text[und][0][value]":false}},"attributes":{"style":"width: 180px; height: 180px; float: right; margin: 2px;","class":"media-element file-preview","data-delta":"1"},"link_text":null}]]Head of Research at the Irish Cancer Society, Dr Robert O’Connor, said: “When people see the daffodil pin on Daffodil Day, they’re given hope. Hope of a better outcome and a brighter future. That’s what Irish Cancer Society Research is all about.

“A survival rate of 6 in 10 is a huge improvement, but cancer research won’t stop until that statistic is 10 in 10. The work of dedicated Irish cancer researchers over the past 30 years and more has given the present generation better, longer lives. The work of today’s researchers and Irish patients who partake in clinical research will potentially mean that future generations can live free from the fear of cancer. By donating to Daffodil Day, the public is supporting the life-saving work of these researchers. For that, we encourage everyone to please get involved in Daffodil Day this Friday, March 24th.”

To mark 30 years of Daffodil Day, here are some of the ways in which cancer research has had a major impact on people’s lives.

Advances in cancer prevention

[[{"fid":"6576","view_mode":"preview","fields":{"format":"preview","field_file_image_alt_text[und][0][value]":false,"field_file_image_title_text[und][0][value]":false},"type":"media","field_deltas":{"1":{"format":"preview","field_file_image_alt_text[und][0][value]":false,"field_file_image_title_text[und][0][value]":false}},"attributes":{"style":"width: 180px; height: 180px; float: right; margin: 2px;","class":"media-element file-preview","data-delta":"1"},"link_text":null}]]Thanks to research, we know how we can substantially reduce our risk of cancer. 4 in 10 cancer cases are preventable by adopting small lifestyle changes, many of which were discovered over the past 30 years. For example, we now know the role of the Human Papilloma Virus as the cause of cervical cancer, as well as some head and neck cancers, and, as a result, the HPV vaccination has been developed. In Ireland this safe and effective vaccine is administered free to first-year secondary school girls to protect against the strains of HPV which cause 7 in 10 of all cervical cancers and one in 40 of all cancers seen in men and women in Ireland.

Reducing the risk of cancer by not smoking, having a healthy mixed balanced diet, keeping active, and avoiding excess sun and alcohol, are all discoveries made through cancer research over the years. As a result, these findings are saving lives.

Better ways of detecting cancer

One of the major ways in which some cancers can be detected early today is screening.

Currently Ireland has three national screening services to detect breast, cervical and bowel cancers.

The National Breast Screening Board was established in 1998 before becoming part of the National Screening Service in 2007. The following year BreastCheck became the first national screening service provider worldwide to offer a fully digital mammography service. BreastCheck has screened over 371,200 women and detected over 5,400 cancers.

Cervical cancer is unfortunately common among women but can usually be cured if detected early through an examination (screen) of cells from the cervix. To make this life-saving test available to Irish women from all walks of life, in 2008 Ireland’s National Screening Service launched a free and accessible cervical screening programme, CervicalCheck.

The National Screening Service also runs the free and simple home BowelScreen test. The bowel cancer screening test looks for tiny amounts of blood which are not visible to the eye, but which can be an early symptom of this malignancy.

Breast, cervical and bowel cancer survival rates are improving in Ireland as a combined result of screening, early detection and more effective treatment options.

Improvements in cancer diagnosis

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Cancer imaging is a vital component in the cancer diagnosis process. The development of CT (computerised tomography) and MRI (magnetic resonance imaging) scanning in the early 1970s paved the way for continued advances in scanning for cancer.

In 1974 the first human positron emission tomography (PET) scanner, an instrument which allows for the scanning of active tumour throughout the body, was built. PET imaging is based on the detection of traces of radiation that are released from mildly radioactive chemicals injected into the blood and taken up by many kinds of cancer and gives even more detail on the extent that a tumour may have spread than CT and MRI.

Since then imaging has continued to improve in quality and is used not only for screening but for the assessment of treatment response, tumour size, and/or recurrence of cancer.

Biomarkers are cancer-specific substances that can be found in blood, urine, or other body fluids, the level of which can indicate the presence of cancer. In recent years tests to detect the presence or absence of biomarkers have become a routine element of diagnosis.

The advent of whole genome sequencing followed by molecular profiling in the early 2000’s provided a platform to allow the identification of the role and relevance of specific changes in genes (mutations) to cancer. As a result, we discovered that when we look at a group of genes or proteins we can not only diagnose cancer, but, in some cases, now predict which cancer medicine will likely work best, and the likelihood of recurrence, thus allowing doctors and patients decide on the best course of treatment, sometimes eliminating the need for chemotherapy treatment altogether.

Improved cancer treatments

[[{"fid":"3158","view_mode":"preview","fields":{"format":"preview","field_file_image_alt_text[und][0][value]":false,"field_file_image_title_text[und][0][value]":false},"type":"media","field_deltas":{"1":{"format":"preview","field_file_image_alt_text[und][0][value]":false,"field_file_image_title_text[und][0][value]":false}},"attributes":{"style":"width: 180px; height: 180px; float: right; margin: 2px;","class":"media-element file-preview","data-delta":"1"},"link_text":null}]]Many cancer medicines in use today were first discovered in the 1950s and 60s. By 1970 advanced Hodgkin's disease was the first cancer of a major organ system that could be cured by chemotherapy, thanks to a combination of therapies being used. In the same decade chemotherapy also began to be used side by side with surgery or radiotherapy.

In the 1980s multiple new drugs were screened for effectiveness as anti-cancer agents. In more recent years, as our knowledge of molecular changes that occur in cancer cells continues to grow, so too has drug development moved towards more targeted, specific treatments, which have less side effects.

In 2001 the first such targeted therapy, imatinib (Gleevec) for a blood cancer, chronic myelogenous leukemia (CML) was approved. Today, significant research has resulted in a huge growth in the number of new, targeted therapies. With this we are also moving towards companion diagnostics which allow patients be tested in advance to ensure the safe and effective use of a drug most likely to work for their individual form of cancer.

Stem cell transplants (also known as bone marrow transplants) are now used to treat, manage and sometimes cure many types of blood-related cancers such as leukaemia, lymphoma or multiple myeloma. These transplants involve patients receiving intensive chemo and/or radiotherapy to wipe out their own cancerous immune system followed by the transplant of healthy immune stem cells from a healthy donor in the hope that these will regenerate a new immune system free from cancer.

The first bone marrow transplants were mostly unsuccessful until we realised that patients and donors must be matched in a specific aspect of genetics (HLA-typed) for a successful transplant. Since the 1980’s it has become possible to perform a transplant using donor marrow from individuals outside the family.

In 1989 the Irish Unrelated Bone Marrow Registry was established to provide a panel of volunteer donors for Irish and International patients. Today there are over 21 million individuals worldwide who have been HLA-typed to serve as an unrelated donor. Advances mean it is now also possible to perform a mini stem cell transplant in people who are not fit or well enough for a traditional transplant, bringing hope to an even wider group of patients.

In the last 30 years researchers have also focussed on therapies which involve encouraging and reengineering the immune system to attack cancer cells, generally known as immunotherapy. The number of immunotherapies being approved for the treatment of cancer has steadily been increasing over the past 5 years. Encouragingly, research shows that many of these immunotherapies appear to have some positive effects for some patients in a wide variety of cancer types. In 2016, 9 immunotherapy drugs were approved across the US and Europe for more than 25 cancer indications. In 2017 this new area of cancer treatment is one of the largest areas of research as it holds the hope for a genuine cure for many previously poorly-responding forms of cancer, such as melanoma.

A new focus on cancer survivorship

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30 years ago the training and availability of psychologists to specialize in issues specific to people with cancer was rare. A 1983 study showed that rates of depression in patients with cancer ranged widely from 1% to 53%, depending on the population of patients and the diagnostic criteria used.

The formation of the International Society of Psychosocial Oncology (IPOS) later established an increasingly cohesive body of knowledge in Psycho-Oncology and facilitated the development of best practice guidelines in the UK, Australia, Israel, Canada, and the USA to help support the difficult psychological challenges that a cancer diagnosis can meet on a patient and their loved ones.

In the last 15 years three dedicated Psycho-Oncology Departments have been established in St. Vincent’s University Hospital, St. Luke’s Hospital and St. James’s Hospital, Dublin.

The Future

Cancer research is becoming more focussed on patient-centred care, not just eradicating the cancer. From new initiatives to embed patient and public involvement in cancer research to patient advocate organisations working with government, industry, and academia, we are making progress in putting patients at the heart of cancer research, as well as policy, treatment innovation and care.

Survivorship will also continue to grow as a research field. Cancer treatments can lead to side effects ranging from long-term fatigue to infertility. Researchers are already talking to survivors to better understand these side effects and find ways to get everyone back to their normal life and health. This can be seen in the IPCOR (Irish Prostate Cancer Outcomes Research) study, funded by the Irish Cancer Society and the Movember Foundation. IPCOR is assessing whether newly diagnosed Irish prostate cancer patients see big changes in their quality of life during and after treatment, and how their care and outcomes compare internationally.

Proposals have been made to embed psychological care for cancer patients in The Department of Health’s upcoming Cancer Strategy, which is due to be presented to the Minister of Health shortly. This strategy will act as the blueprint for our cancer services over the next decade.

And at the heart of cancer research will continue to be the goal to save lives. The Irish Cancer Society is backing the goal through funding projects such as BREAST-PREDICT, a €7.5 million country-wide collaboration among more than 50 breast cancer researchers across Ireland. Sharing skills and expertise, BREAST-PREDICT collects information and tumour specimens from breast cancer patients so that researchers can better understand this disease and find ways to individualise treatment for a better anti-cancer effect.

Currently the Irish Cancer Society funds more than 100 cancer researchers in Ireland. Their work is forming the basis of new discoveries that could improve and save future lives. None of this would be possible without the public’s generosity on days like Daffodil Day.