When the uterus or the breast, the prostate or the testicles are affected, specialists speak of ‘gender-related cancers’. Although the biological mechanisms at work resemble those of all cancers, these have a number of specific features in common, both in men and in women. One is their high incidence rate – which makes them a real public health problem – and another is the psychological aspect of an illness that strikes at the most intimate parts of a person’s anatomy. Nevertheless, there is hope on the horizon thanks to systematic screening (especially of the uterus, breast and prostate) that is beginning to have an impact. In addition, biomedical research in diagnostics and therapeutics is paving the way to new forms of treatment for these gender-related cancers. RTD info takes a look at European research in this field.
Let us call them Clara, Brigitte and Lisa. While breastfeeding her first child, Clara was surprised to notice a hard lump in her left breast. She immediately thought of her mother, of one of her aunts… and soon understood. It was at the time of a routine visit to her gynaecologist that Brigitte was found to have a lump. As to Lisa, she was hardly surprised they found a growth, given how much she had feared the appearance of this symptom every time she went for a follow-up mammogram following her illness. Clara, Brigitte and Lisa – together with another 275 000 women in Europe every year – developed breast cancer. It is a disease that changed their lives. However determined the patient may be to fight it, the statistics make grim reading: with 88 400 deaths a year, this kind of tumour is the principal cause of mortality for women aged between 35 and 55 in Europe.
Intimate enemies Specialists have identified more than a hundred types of cancer. Varying in seriousness, they follow different courses but share the same mechanism. For reasons we do not yet fully understand, a cell suddenly decides no longer to obey the internal signals of the body and starts to divide uncontrollably. That causes a tumour to form. Cancer cells then escape from this tumour and set off to colonise other parts of the body where they form metastases. Nearly all the body’s organs can be affected by this malignant transformation. When it is the uterus, ovary, breast, prostate gland or testicles that are affected, we speak of ‘gender-related cancers’. Although fundamentally no different to other cancers in terms of the biological mechanisms at work, they do have three specific factors in common.
The first is the public health problem they present by virtue of their high incidence and their seriousness. After cancers of the respiratory system, breast and prostate cancers are the third and fourth most common cancers in Europe (13% and 8.2% respectively) and the fourth and fifth in terms of mortality. Tumours in the uterus and testicles are less common and also less serious as they are easier to treat. The second link between these types of cancer is that they strike, by virtue of the organs affected, at an essential and intimate part of our identity. As a result, the illness can be particularly difficult to cope with. Finally, hormonal mechanisms play a major role in all these cancers.
Why me? That is what Clara, Brigitte and Lisa asked themselves, like everybody does when suddenly faced with the disease. Although there are descriptions of cancer dating back to antiquity – Hippocrates describes breast cancer, for example – it is a question that long remained unanswered. François Dagognet, a philosopher of medicine, sees cancer as partly linked to ‘the inside’ – that is, to our genetic make-up – and partly linked to ‘the outside’ – our relationship to our environment.
In 1977, two British epidemiologists working at the International Agency for Research on Cancer in Lyons, John Higginson and Calum Muir, were the first to provide quantitative elements of a response to this question. In a famous study, they showed that 80% of cancers were attributable to causes linked to our environment in the broadest sense, including diet, lifestyle (smoking, drinking and lack of exercise) or passive exposure to a range of pollutants. This figure is now generally accepted, although allowances must be made for different types of cancer. It provides the basis for one of the principal strategies in the fight against the disease. As Olaf Kelm, who monitors studies on cancer under the Research Directorate-General’s Sixth Framework Programme at the European Commission, explains: “As 80% of cancers are attributable to the environment, this means that a large proportion of them are avoidable. Consequently, prevention is the most effective strategy for reducing the number of people suffering from the disease.”
Seeing through the smokescreen This prevention strategy demonstrated its effectiveness in the case of lung cancer. We may scarcely remember it today, but the idea that smoking is a cause of cancer took a very long time to gain credibility. It is thanks to the obstinacy of the British doctor Richard Doll, who died last year, that awareness of the link was progressively achieved. Over 50 years, from 1954 to 2004, he monitored the state of health of a cohort of over 30 000 people, publishing studies every decade. Respecting the utmost rigour, these showed a considerable increase in the risk of lung cancer in particular – but not exclusively – in direct proportion to smoking.
Doll’s exemplary scientific studies also had a profound impact on public health. They enabled us to understand the reason for the rapid increase in the incidence of lung cancer during the 20th century, an increase that was as difficult to explain as it was to stop. Most importantly, in the 1970s, they gave rise to the first advertising campaigns warning the general public of the dangers of smoking which have paid off as the incidence of lung cancer declines.
Know thy enemy The EU-backed Eurocadet programme is all about prevention. The project stems from a stark reality: there is still no evaluation of the impact of national and European cancer prevention campaigns. Although they are one of the principal strategies in fighting cancer, we remain unaware of the overall effectiveness of these campaigns, “especially among the working classes”, say the coordinators. By comparing the data obtained by 14 teams of epidemiologists, Eurocadet aims to compile a picture of the cancer situation in Europe in 2004 in relation to different prevention scenarios.
Prevention also means the earliest possible diagnosis of the disease. The earlier a tumour is detected, the greater the chances of treatment working successfully. For women, the practice that has become most commonplace is the cervical smear test routinely carried out at the time of gynaecological check-ups. In countries that have introduced it, this has reduced mortality due to uterine cancer by almost 80%. Mammograms, every year or every two years for women over 50, are also bringing promising results. Men have not been forgotten either. Launched in 2000, the European Randomised Study of Screening for Prostate Cancer today assesses, at European level, the effectiveness of systematic screening for prostate cancer after a certain age. The first results are expected from 2007.
Founded in 1996, the European Institute of Women’s Health is seeking to promote women’s health issues in the European policy domain. This non-governmental organisation works in close cooperation with EU institutions in encouraging research (on diseases that affect only women or the gender-specific ...
TO FIND OUT MORE
Eurocadet (Key determinants of the future incidence of cancer across Europe: impact of prevention) – Contribution UE: 987 963€
ERSPC (European Randomised Study of Screening for Prostate Cancer) – Contribution UE: 949 825 €
Founded in 1996, the European Institute of Women’s Health is seeking to promote women’s health issues in the European policy domain. This non-governmental organisation works in close cooperation with EU institutions in encouraging research (on diseases that affect only women or the gender-specific aspects of other conditions) as well as public health actions (training of doctors, campaigns aimed at women and lobbying of European leaders). This NGO is endeavouring to place health issues at the centre of the concerns of the future European Gender Institute, the creation of which was announced last March by Vladimir Spidla, EU Commissioner responsible for employment, social affairs and equal opportunities.