Research ReportIssue 24 • November 2013

Forgotten cancers2 Bringing research

funds and resources to bear on this area

FEATURED: Our Staff2 5 minutes with

Dr Lini Nair-Shalliker

Our Insights3 A small change to

Death Registration could save lives

Research Discovery4 How cancer cells

learn to resist drug treatments

Cancer Council 13 11 20cancercouncil.com.au

CLEAR Study: We can now make our data available to cancer researchersCancer Council NSW invites other cancer researchers to discuss projects for collaboration.

The NSW CLEAR study has collected data from over 9,000 people with and without cancer to provide a better understanding of the genetic and environmental causes of cancer in NSW.

The study was designed as an open resource for cancer researchers, and the data and blood samples have now reached sufficient maturity to be made available to the cancer research community.

Scientists can use the CLEAR data and blood samples to evaluate risk factors for cancer. Particular interest will be links between cancer and smoking, infectious agents, hormones, sun exposure and sleep patterns, BMI/physical activity, and alcohol.

As the CLEAR Study is an open resource, scientists may apply to use questionnaire data and blood samples for any cancer research project, subject to scientific and ethical approval, without collaboration with Cancer Council NSW. However, we also encourage researchers to discuss with us opportunities for collaborative projects, especially those which bring expertise outside our areas of content knowledge.

Visit clearstudy.org.au or email clearstudyenquiries@nswcc.org.au

Male 7 440 114 223 975 85

Female 1,504 338 129 233 – 93

Total 1,511 778 243 456 975 178

Cancer

type BreastBowel

LungMelanoma

ProstateNon-

Hodgkin’s

Lymphoma

CLEAR Study data available by major cancer types

Control 1,342 140 4 8 19 29 7

Case 4,246 460 50 66 54 113 34

Total 5,588 600 54 74 73 142 41

AustraliaEngland

HollandChina ItalyBirthplace

CLEAR Study data by birthplace

NZ Greece

<40 40-49 50-59 60-69 70-79 80-89 90-99

Age

Part

icip

ants

2,000

1,500

1,000

500

0

Case

Control

CLEAR Study data by age

Cancer Council 13 11 20cancercouncil.com.au

Forgotten cancers cause more than a third of all cancer deathsThey account for 35% of all NSW cancer deaths yet are under-funded and under-researched.

“Many cancer types are grossly under-funded and under-resourced, yet they are among the most common causes of cancer deaths in Australia. We call these the forgotten cancers,” said A/Professor Freddy Sitas of Cancer Council NSW.

Figures recently released by Cancer Council NSW show pancreatic and thyroid cancer have seen the least improvements in cancer death reduction over a 20 year study period — only a 6% reduction in death rate, while liver cancer has seen an increase.

Under-funded cancers such as pancreatic cancer, cancer of the unknown primary, and liver cancer are in the top ten most common causes of cancer death in Australia, while brain cancer remains the leading cause of cancer death in children and young people.

On average, 40 Australians die from these forgotten cancers every day. Because of this, Cancer Council NSW has made many of these cancers a key focus for new research. Brain and pancreatic cancer are our second and third most funded cancers, each receiving close to $1m in research funding this year.

For more information, visit cancercouncil.com.au

A reminder that forgotten cancers are killing people yet receive little attention, funding or support for their sufferers

Five minutes withDr Lini Nair-ShallikerWhat is your position within Cancer Research Division?I started as a PhD student through the University of Sydney. After that I was employed as a Research Fellow for the CLEAR Study in 2011. I manage the operations and strategic direction of the CLEAR Study under the guidance of the study’s investigators.

How will the CLEAR Study benefit Cancer Council NSW?By reinforcing the organisation as a reputable and innovative research institution in the forefront of cancer research.

From your perspective, why is the CLEAR Study important?The aim of CLEAR is to study gene-environment interactions and to try to discover whether a disease like cancer can be prevented by reducing our exposure to environmental risks. It is one of the few studies that has such a concise collection of a variety of environmental, social and lifestyle factors as well as blood and tissue samples.

What are the aims for the CLEAR Study now?We are focussing on recruiting from our culturally and linguistically diverse community. We have translated our study materials into 5 languages and are looking for help to distribute this new information.

Dr Visalini Nair-Shalliker

For more information, visit: cancercouncil.com.au

We are close to reaching the initial 10,000 recruitment target for the CLEAR Study. Only 450 to go! Our next target will be 25,000.

And we are beginning to promote the availability of the data (bloods and questionnaires) to other researchers with the goal of attracting collaborators.

Cancer Council NSW Research Report

Here’s a simple question that could save lives:“Was the deceased a smoker five years ago?”

A new report highlights how this simple yes/no question about smoking on South African death registration forms has led to new understandings about deaths caused by smoking, and provided a valuable profile of the effect of smoking on different population groups in that country.

This new insight has stimulated leading Australian researchers to call for a similar question on smoking to be included on death registration forms in Australia and around the world.

Lead author and cancer epidemiologist, A/Professor Freddy Sitas, Cancer Council NSW, plans to present these key findings to the World Health Organization. “This model should become international best practice for any country that has reasonable death certification.”

Eminent international cancer epidemiologist, Professor Sir Richard Peto from Oxford University, and another lead author on the study, adds: “This is a

cheap and easy intervention that ought to be implemented worldwide.”

South Africa is the only country to record smoking status on the death certificate. “Working with colleagues in South Africa and the UK we analysed half a million deaths from South Africa, making this one of the largest studies on death from tobacco in the world,” said A/Professor Sitas.

”What surprised us were the striking differences in the profile of deaths from smoking in each population group — in the black population we found that the main way it killed was by increasing the mortality rate from tuberculosis, cancer and other lung diseases. In the white population we saw an increase in risk from cancer and heart disease, but surprisingly an increase in respiratory diseases. The mixed race population smoked more than any other group and had about double the death rate from smoking than that of white South Africans. This is of real relevance to countries with large multi-cultural populations, like Australia.”

For full article and comment, visit:http://press.thelancet.com/southafricasmoking.pdf

Issue 24 • November 2013

Although smoking levels in Australia are declining, tobacco is still one of the leading causes of preventable deaths affecting 15-19,000 people per annum.

To arrive at these figures, Australia extrapolates estimates from other western countries, “but in a multicultural country like Australia we ought to be getting more accurate data and trends over a long period of time,” said A/Professor Sitas.

“If we replicate this work in Australia the results could be more startling than expected. There could be a huge variation in smoking related deaths among our indigenous, migrant, rural populations, or those who are marginalised. Accurate information will help us focus our prevention programs. We could also find out more details about the range of diseases directly linked to smoking. There are about 60,000 doctors in Australia and about 150,000 deaths per annum. We are really not talking about a lot of extra work.”

The study was funded by the South African Medical Research Council, the UK Medical Research Council, Cancer Council NSW, Cancer Research UK and the British Heart Foundation.

“…a simple yes/no question on death registration forms has led to new insights about deaths caused by smoking.”

Question on South African Register of Death form

Population group Black White Mixed

Smokers

Leading cause ofdeath: 1 Tuberculosis Ischaemic heart

diseaseTuberculosis

2 Other respiratory disease

Chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease

3 Upper aerodigestive cancer

Lung cancer Other respiratory disease

Male Female

50% 12%Male Female

47% 28%Male Female

68% 46%

Leading cause of death in smokers in South Africa

A/Professor Freddy Sitas awarded AG Oettlé Memorial MedalThis medal is awarded to South Africans who through original research have made valuable contributions in regard to cancer A/Professor Freddy Sitas, Director of the Cancer Research Division, has received the prestigious AG Oettlé Award for his pioneering epidemiological work at the National Cancer Registry in South Africa.

between the cancer cells. The micro particles dock onto a drug-sensitive cancer cell and within two hours they release their contents into the cell. As early as four hours later that cell is multi-drug resistant cancer cell.

If A/Professor Bebawy and her team can understand how these cells resist treatments, this could lead to the development of new drugs able to circumvent them or tests to detect when cells are becoming resistant to therapy.

Cancer cells teach each other how to resist treatmentIt can take just four hours for a cancer cell to learn how to resist cancer drug treatments.

Over time cancer cells can become resistant to drugs. Now A/Professor Mary Bebawy has made a remarkable discovery as to how it happens: she found that resistant cells actually share with other surrounding cells the ‘knowledge’ necessary to protect them from cancer treatments.

A/Professor Mary Bebawy, together with Professor Georges Grau, found a previously unknown mechanism for cancer cells to teach each other how to resist treatment. A resistant cancer cell can shed tiny vesicles, or micro particles, from its surface. These vesicles are actually tiny packages full of genetic information that act as messengers

Drug resistant cells can share their ‘knowledge’ with surrounding cells

For more information, visit: cancercouncil.com.au

Help us beat cancerRegister to join a research study today!

Cancer Council and other academic bodies conduct research studies to do with cancer. These studies may be questionnaire based surveys, focus groups and interviews or other types of research. Study participants will not necessarily be cancer patients.

Register your interest to be included on our database. Your story or the story of someone you know will help us find the answers.

Yes, include me on the database. (If yes, we will write to ask you some additional questions relating to your health to allow us to match you to research studies that suit you.)

Tick this box if you have been diagnosed with cancer in the past 18 months. (If yes, you may be eligible for the CLEAR Study and we will send you further information.)

Title*

First Name*

Last Name*

Address*

Town*

Postcode*

Email

Phone

Mobile

* Mandatory

CA

N 2

030

11/1

3

Return completed form to: Reply Paid 79819 Potts Point, NSW 1335

You can also register at cancercouncil.com.au/joinastudy

At Cancer Council we recognise the importance of your privacy and the safeguarding of your personal information. If you have concerns about the privacy of this information, you may provide it securely online at cancercouncil.com.au/joinastudy. Please be assured that in collecting this information, it will be used for research purposes only, and will be handled in accordance with our Privacy Management Plan (www.cancercouncil.com.au) which addresses our compliance with all legislative requirements.