Monday, 16 November 2015

Photons, Protons, Red Wine and Aspirin

No early start for me on the Tuesday of the conference.  My first session was the 09.40hrs Technical Developments in Radiotherapy, a highly accessible plenary lecture by physicist Uwe Oelfke.  A highly skilled speaker, he led us through advances and opportunities in planning radiotherapy and the advantages and drawbacks of, and differences between, the various options for delivering radiotherapy.  He also discussed the possibility of integrating MRI to fine tune delivery and enable real time adapted radiotherapy.

For me, the other outstanding session of the day was Prevention is Better than Cure, hosted by Jack Cuzick.  The opening paper from Andrew Chan reviewed the role of aspirin and pointed out that the reason why it takes 6 - 10 years to see benefit is probably down to the length of time it takes for cancer to develop and aspirin appears to reduce the risk of precursor adenomas.

Sam Behjati then presented the findings of a small study that looked at 4 different types of radiation-associated second malignancies.  In spite of genomic diversity between these, the study found a couple of mutation signatures in common irrespective of tumour type, namely excess numbers of balanced inversions and of deletions.  Looking to the future, he posed the question - can these features be used as biomarkers?

From there we went to a consideration of resveratrol (found in berries and in grape skins, hence the reference to red wine).  However, the studies concerned used it in concentrations much higher than those occurring naturally.  Then it was on to a trial of interventions to improve the take-up of cervical screening in young women.  Something I found interesting (but not particularly surprising) was that the only intervention to show even a slight increase in uptake was a limited offer of online appointment booking.  However, overall the trial showed that no intervention showed a significant increase in uptake and, in general, women went for screening when they got round to it.

The session was concluded by Jack Cuzick speaking about benefits and harms.  Considering aspirin, a straw poll of delegates in the session suggested a significant number were taking aspirin (presumably many self-medicating) in spite of the potential side effects.  Trials which have reported using SERMs and AIs in breast cancer prevention show benefits for both, although both carry side effects.

The issue of side effects makes it useful to stratify the population and offer chemoprevention to those most likely to benefit.  In the case of aspirin, this can be tricky because benefits can be seen for a range of cancers, further complicated by the population wanting to look at all cancers when considering risk/benefit.  For the endocrine therapies, the target group is more easily identified.  One suggestion was that screening appointments could be a window in which to provide people with information on prevention options.

I would have liked to have attended the 18.00hrs clinical trials showcase followed by the 'Rethinking Cancer' plenary, but it had been a very full day, including poster viewing and an important lunchtime workshop on involving patients in the use of their data - more of which in a future post.  Reluctantly I decided that, with an evening event to follow, I'd better go back to my room and put my feet up for a while.

After that, it was some important socialising.  After all, networking is an important element of the conference and what better way to do that than over a good dinner and a bit of a dance?!