10 The Sunday Times June 5, 2022
NEWS
Thousands of bowel cancer patients
every year will be spared chemotherapy
thanks to a revolutionary blood test that
detects if they have been cured.
Nine in ten patients with early-stage
bowel cancer have surgery to remove
their tumour, with one in four then
undergoing chemotherapy to ensure that
all the cancerous cells are killed. Until
now doctors have had no way of knowing
if surgery had removed all the cancer,
meaning that thousands of patients
unnecessarily end up on chemotherapy
as a precaution.
Now scientists have developed a test
that looks for tiny fragments of DNA from
bowel cancer tumour cells circulating in
the bloodstream. Patients who test nega-
tive for tumour DNA can avoid further
treatment and its side effects.
It is hoped that the test will be intro-
duced in the NHS in three years, sparing
6,000 patients a year chemotherapy and
saving the health service £16 million in
treatment costs annually.
About 270,000 people in the UK have
bowel cancer, with more than 42,
new cases diagnosed every year and
16,500 patients dying.
The new test could be used on 13,
patients a year with stage 2 or 3 bowel
cancer, which has not spread to other
parts of the body.
A trial led by the University of Mel-
bourne involving 455 bowel cancer
patients found that the test halves the
number of patients undergoing chemo-
therapy without increasing the risk of
relapse.
Of 302 patients who were given a blood
test, only 15 per cent tested positive for
cancer DNA and went on to have chemo-
therapy.
For the other group, of 153 patients —
where doctors relied on their clinical
judgment alone to decide if patients
give doctors the intelligence they need to
beat cancer sooner.
“Determining which patients might
benefit from chemotherapy in stage 2
colorectal cancer is a difficult area and
has traditionally been based on clinical
and pathological criteria. Liquid biopsies
can pick up tiny fragments of tumour
DNA circulating in the bloodstream after
surgery, which can give doctors an early
warning sign that a patient’s cancer is
coming back, which might need furtherDame Deborah
James’s BBC
podcast You, Me
and the Big C
brought her famechemotherapy to reduce the risk of the
tumour returning.
“This study provides evidence that
testing for tumour DNA in the blood-
stream after surgery can find patients at
high risk of relapse, and identify which
patients may benefit from further rounds
of chemotherapy.
“Importantly, this study provides evi-
dence that the blood test is as good as
traditional clinical and pathological crite-
ria for chemotherapy use after surgery.”weekend at the annual
meeting of the American
Society of Clinical Oncology,
whose charitable foundation
is called Conquer Cancer.
War metaphors have been
largely written out of NHS
cancer policy documents
over the past two decades,
after experts warned they
could evoke feelings of fear
and thoughts of death and
pain. Earlier this year Sajid
Javid, the health secretary,
declared a “war on cancer”
under a new ten-year plan to
tackle the disease.
Zsofia Demjen, associate
professor of applied
linguistics at University
College London, said her own
research into the topic
concluded that some military
metaphors can be motivating.
She said: “We found
similar evidence that...
referring to each other as
‘fighters’, and telling each
other to ‘soldier on’, these
types of metaphors really had
a motivating effect.”Military words such as “fight”
or “battle” empower people
with cancer, helping them to
stay optimistic and persevere
with gruelling treatment,
according to new research.
Doctors have been told to
avoid war metaphors in case
they leave patients feeling
frightened and powerless.
But the new study found
phrases such as “battling
cancer” or “beating” the
disease to achieve “victory”
were overwhelmingly
positive and beneficial.
Scientists questioned 15
patients with lung, breast and
bowel cancer about using the
concept of war to describe
and understand their illness.
“It did things like give them
hope when their treatment
got them down,” said Monica
Bodd of Duke University, the
lead author on the paper.
“Some would say: ‘I fought X,
Y and Z when I was growing
up, this is just another fight.’
“War metaphors promoted
perseverance in the face of
adversity, expressed
optimism, and allowed them
to relate cancer to previous
life challenges.”
The only patients who did
not use war metaphors were
those with terminal cancer,
who found them “unhelpful
due to their sense of having
no control over the
outcome”.
The study is being
presented in Chicago thisEleanor HaywardTerms
such as
‘victory’
helpedBlood test could spare thousands of
patients needless chemotherapy
needed further treatment — 28 per cent
were given chemotherapy.
The research, presented this weekend
at the American Society of Clinical Onco-
logy’s conference in Chicago, followed
patients for three years after surgery and
found that the two groups had identical
relapse rates.
Professor Jeanne Tie, the lead author,
said: “We can reduce the number of
patients having chemotherapy — and for
the individual patient, being told they
don’t need chemotherapy is fantastic.
“One of the most exciting bits [of this
research] is seeing [DNA positive
patients] have such favourable outcomes... because that was one area that I think
a lot of clinicians will still have some
doubt about.”
A similar trial is being run in the UK by
Professor David Cunningham, an oncolo-
gist at the Royal Marsden Hospital, Lon-
don, who said the test could save NHS
resources and help to clear the record
backlog of cases in the wake of the coro-
navirus pandemic.
Cunningham said DNA blood tests
could soon be used “across the board” to
detect cancers, allowing early diagnosis
and reducing the number of people need-
ing chemotherapy.
“It’s common sense, isn’t it? Early
diagnosis leads to better outcomes. And if
you could go to your GP once a year and
get a blood test [to look for cancer DNA]
at the same time as you get your lipids
measured, and blood pressure taken,
that would surely be a very good thing,”
he said.
The trial at the Royal Marsden is part of
a series of world-leading research pro-
jects into bowel cancer in the UK.
Dame Deborah James, 40, host of the
BBC podcast You, Me and the Big C, has
raised £6.6 million for research into
bowel cancer since announcing last
month that she was receiving end of life
care. Her damehood was conferred at her
home by the Duke of Cambridge.
The money from the Bowelbabe fund
will be shared between Cancer Research
UK, the Royal Marsden and the Institute
of Cancer Research.
Professor Charles Swanton, Cancer
Research UK’s chief clinician, said: “This
exciting study offers a glimpse into the
future, where personalised DNA tests can
The ability to detect DNA
fragments in bowel
cancer sufferers may
offer the chance to avoid
gruelling treatment
Eleanor Hayward Chicago
Military metaphors
persuade those in
pain to soldier on
SUNDAY TIMES PHOTOGRAPHER RICHARD POHLE