It is said that it takes 21 days to form a new habit so for 2021, the team at the Union for International Cancer Control (UICC) are urging people around the world to take up 21 days of action to fight cancer.

This is a particularly important year to take action on cancer as many people missed important pathology tests during the pandemic restrictions, including cancer screening. Also, the President Elect of UICC for 2020-2022 is Australian Jeff Dunn, who we know better as CEO of Prostate Cancer Foundation of Australia (PCFA).

There are 5 different challenges you can sign up to; one of these is a pledge to help eliminate cervical cancer so we’d remind anyone with a cervix to book in for their Cervical Screening Test if they are overdue, and also remind those you care about to do the same.

Another action is to get informed about cancer and that’s where KPKH can help you get started. Check out the videos and articles below to learn more about how pathology testing helps fight cancer. (Diagnosing 100% of cancers is pretty impressive but it doesn’t stop there).

1. Broadening gene testing could prevent thousands of cancer cases

2. WATCH: Cervical cancer screening explained

• What happens if you test positive for HPV?
• What is the difference between the old ‘pap test’ and the current Cervical Screening Test?
• What do pathology professionals want you to know about cervical cancer and screening?

3. Cancer survivor Iain meets the hidden doctor who made diagnoses during his operation and guided the surgeon’s hand 

4. WATCH: From parliament to pathology – Jim Lloyd learns how a prostate cancer diagnosis is made 

5. How Snowdome Foundation is making hope real in the blood cancer battle 

6. Low screening tate “astounding” in light of increased bowel cancer cases 

The post World Cancer Day – take the 21-day challenge first appeared on Know Pathology Know Healthcare.

This latest research paper looked at testing for BRCA1 and BRCA2 – genes associated with increased risk of breast and ovarian cancer. Although not the only genetic abnormalities that are associated with increased risk, BRCA1 and BRCA2 are the most recognised breast and ovarian cancer-causing genes.

These gene mutations cause around 10-20 per cent of ovarian and 6 per cent of breast cancers. If mutation carriers could be identified before they develop disease, most of these cancers could be prevented by drugs, increased screening or surgery.

WATCH: Channel 10 news story on BRCA testing research with genetic pathologist, Dr Melody Caramins

The research suggests that screening more widely for breast and ovarian cancer gene mutations could prevent millions more breast and ovarian cancer cases across the world compared to current clinical practice. The research also shows that it is cost effective in high and upper-middle income countries. This means if guidelines were changed to offer screening to more women this could be beneficial to patients and the health system in the Australian economic landscape.

Genetic testing in Australia

As with all pathology tests, genetic testing is provided within a medical framework to ensure that testing is offered where it is clinically appropriate, offers benefit to the patient and is completed under strict quality guidelines. All predictive genetic testing must be done in the context of pre-test genetic counselling by highly qualified specialists as there are complex consequences for the patient and for their family that must be discussed prior to testing. This allows people to make an informed decision about whether to have the test.

Currently in Australia the guidelines to refer someone for testing are quite strict and rely on specific family history of cancer. This research makes the case to potentially reconsider those clinical guidelines for this type of testing, and whether the current threshold is appropriate and the most beneficial for Australian patients and the health system.

Nicole Braude is an ambassador for Pink Hope, an Australian organisation that provides women the necessary tools to assess, manage and reduce their risk of breast and ovarian cancer, while providing personalised support for at risk women. Nicole’s grandma died from breast cancer when she was only 34 years old. Getting the appropriate testing was something that was always in the back of Nicole’s mind growing up.

Speaking about her and her family’s experience of genetic testing and breast cancer Nicole said: “It turns out genetic testing was the best thing we ever did as it saved my sister’s life. They found the gene and she had a double mastectomy. I decided to have preventative surgery too after I took a risk assessment which revealed I had an 89.7% chance of developing breast cancer before the age of 40.I had the surgery and never looked back, I’m now 25 weeks pregnant and my baby is BRCA free. That news came as such a relief because my child will never have to worry like I did.”

Let’s talk numbers

Findings by Queen Mary University of London suggest that population based BRCA testing can prevent an additional 2,319-2,666 breast cancer and 327-449 ovarian cancer cases per million women than the current clinical strategy. The table below explains how that would be translated in terms of preventable deaths in each of the countries examined in this particular study.

Dr Melody Caramins is the National Director of Genomics and former chair of the Royal College of Pathologists of Australasia’s Genetics Advisory Committee. Speaking about the research findings Dr. Caramins said:

“The research results are startling and confirms that we must invest in cancer prevention. By broadening a simple genetic test and offering it to a wider population we could save thousands of Australian lives. Identifying a mutation at an early stage is the key and now we know that it can be cost effective within the healthcare system. The research findings are truly amazing.”

BRCA screening tests are available in Australia but only those who fit certain criteria, such as a strong family history of breast cancer, will be referred for testing. Broader population screening is not currently available.

Any changes to clinical guidelines for BRCA screening tests would require careful consideration and ensuring the appropriate resources were in place to support individuals and families. Genetic counselling is an important part of the process and must be available to anyone being offered testing. This is a highly skilled and complex role that requires years of training.

There are online resources available such as Pink Hope’s Know Your Risk tool, which was developed in partnership with Peter MacCallum Cancer Centre. Anyone who is concerned about their risk of breast or ovarian cancer can also speak to their GP in the first instance who may then refer them to a Family Cancer Centre, Clinical Geneticist, or Genetic Oncologist.

This research was led by Prof Ranjit Manchanda (Queen Mary University of London) and supported by Dr Rosa Legood (London School of Hygiene & Tropical Medicine). This research was an international collaboration involving research teams from Queen Mary University of London, London School of Hygiene & Tropical Medicine, and involved Amsterdam UMC, Vrije Universiteit Amsterdam (Netherlands); Universidade de Sao Paulo, Sao Paulo (Brazil); Peking University, Beijing (China); Indian Institute of Technology, Kharagpur (India); Presidency University, Kolkata (India); Tata Medical Centre, Kolkata (India); University of Melbourne, Victoria (Australia); Newcastle University (UK).

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The blood test, also called a “liquid biopsy” is being trialled all across Australia and New Zealand at more than 40 hospitals, and is showing promising results.

What the test is able to determine is the risk of a cancer returning post-op, thus helping determine the correct dosage of chemotherapy a patient may need.

Chemotherapy, a common treatment for a number of cancers, is currently used post surgery to remove any “residue” of the cancer that may be left behind.

While some people are completely cancer free after having the tumour surgically removed, others are at risk of a recurrence. Currently patients are assessed using results from pathology testing of the tumour and evaluation of other risk factors.

This means chemotherapy is prescribed for patients who are considered high risk, without knowing whether it’s necessary, to ensure the cancer does not return.

So there are patients who are being administered anti-cancer drugs when they may not need them.

However, this new blood test could be the indicator that ensures that unnecessary chemotherapy treatments are a thing of the past.

What this blood test is able to do is look for fragments of tumour DNA that have spread to the bloodstream, something that was previously unachievable.

Chemotherapy, while effective, comes with a number of side effects such as; fatigue, nausea, hair loss, anaemia and nerve damage.

For any patient, these are side effects they would like to avoid if they are able to.

Dr Graeme Suthers, Director of Genetics at Sonic Healthcare, says that the research “is a great example of advances in pathology technology that promote accuracy and have clear benefit to patients”.

“It’s great that a trial like this is being conducted on a large scale because this is a technology that could be used to help the wider population across a number of different kinds of cancer.”

“When something like this can be accessed by more people, it not only benefits the patient by helping them avoid unnecessary negative side effects but it can save the health sector money by decreasing the number of chemotherapy treatments that are administered.”

“As further clinical uses of this type of testing are identified, we are likely to see more trials like this, that can offer insight into where testing is most appropriate and beneficial for patients, and the health system.”

The liquid biopsy trials began in 2015 for early-stage bowel cancer patients and were later extended to women with ovarian cancer in 2017. The next step in the trial will focus on pancreatic cancer.

More than 400 people are currently participating in the trial, but there is potential for this number to increase to more than 2000. It is expected to run until 2021 for bowel cancer and 2019 for ovarian cancer.

*Image: Bowel Cancer Australia

The post New blood test could spare cancer patients chemotherapy first appeared on Know Pathology Know Healthcare.

It reveals poor knowledge of bowel cancer risk factors and screening recommendations among Australians aged 18 – 85 years, increasing the risk of missed tests and delayed diagnosis.

• Almost half (47%) of respondents aged 50+ were unaware of the recommended bowel cancer screening test
• Only 39% of respondents knew how often the test should be undertaken
• Less than a third of respondents knew the recommended minimum screening age
• Only 24% of respondents correctly identified bowel cancer risk factors

Bowel cancer is Australia’s second biggest cancer killer. It is estimated that 33,000 Australians will die of bowel cancer by 2025. In Australia there are 15,253 people diagnosed with bowel cancer each year and 2,186 of these people were under 55.

According to the study, fewer than a quarter of those surveyed could identify the risk factors that could increase their chances of developing bowel cancer.

Lifestyle related risk factors for bowel cancer include; smoking, alcohol consumption, being overweight and a diet low in fibre. These risks can all be modified by changes to lifestyle.

Other risk factors are age, genetics, personal and family health history. People with one or more of these risk factors should speak to their GP about bowel cancer screening.

At the time of the study the National Bowel Cancer Screening Program was underway (Dec 2015 – Mar 2017), and this invited eligible Australians to undertake at-home screening tests.

“Affecting men and women, young and old, bowel cancer often develops without any warning signs,” said colorectal cancer surgeon Graham Newstead AM.

“That’s why Australians need to know the risk factors, make necessary lifestyle modifications, participate in screening appropriate to their level of risk, and be on the lookout for symptoms suggestive of bowel cancer,” Dr Newstead said.

“Unfortunately, the report shows that knowledge of bowel cancer risk factors and screening recommendations remains dangerously low,” said Bowel Cancer Australia Chief Executive Julien Wiggins.

“Studies show participating in screening can reduce your risk of dying from bowel cancer by 16%.
From age 50, Australians can take advantage of the taxpayer-funded National Bowel Cancer Screening Program (NBCSP).

However, people are encouraged to speak to their GP about individual circumstances and participate in screening appropriate to their personal level of risk.”

Possible symptoms of bowel cancer may include:

• A persistent change in bowel habit, especially going to the toilet more often of having looser, more diarrhoea-like movements
• Blood in the bowel movement or rectal bleeding
• A change in appearance of bowel movements (e.g. narrower stools or mucus in stools)
• Unexplained anaemia causing tiredness, weakness or weight loss
• A lump or swelling in your abdomen

It is important to note that these symptoms are not necessarily indicative of cancer, other medical conditions, some foods and certain medications can also cause these changes.

Pathology testing, physical examination and other diagnostic tools can help doctors to determine the cause of any symptoms. Anyone experiencing symptoms such as those listed should talk to their doctor about them.

“When diagnosed at the earliest stages, 90% of bowel cancer cases are treatable,” Mr Wiggins said.

“But early diagnosis is only possible if patients with a positive screen result or symptoms suggestive of bowel cancer can access the necessary follow up, such as colonoscopy, within the recommended timeframe,” said Mr Wiggins.

“Symptoms suggestive of bowel cancer require timely investigation via colonoscopy, so don’t wait until it’s too late,” urged Mr Wiggins.

The post Poor awareness of bowel cancer screening a worrying risk to Australian adults first appeared on Know Pathology Know Healthcare.

70% of medical decisions rely on pathology. The service plays an invaluable role in the detection, diagnosis and treatment of disease. Whether it’s a routine health screen, cancer diagnosis, or blood donation— patients depend on pathology in every country across the globe.

Australia boasts 1,800 pathologists and 35,000 people working in pathology, including roles that range from medical scientists to lab technicians and collectors. These are the people responsible for processing 500 million samples each year.

With the highest global quality standards, rapid turnaround times and highly trained workers, Australian pathology is literally world class and should be recognised as such.

On International Pathology Day, events are being held around the world to explore the potential of pathology in addressing global health issues.

London will play host to ‘Pathology and Cancer’, a live webinar roundtable discussion on the critical role of pathology in meeting the commitments of the World Health Organisation’s (WHO) Cancer Resolution.

Organised by the British Royal College of Pathologists, this important roundtable will bring together an internationally-renowned panel of speakers to explore ways to ensure international cancer control plans adequately address the provision of effective and affordable pathology services.

In Malaysia, students and aspiring pathologists from University of Malaysia Sarawak, will host a celebration at the Museum of Anatomy and Pathology. The interactive event will feature scientifically themed games and food to teach students about the value of pathology.

Back in Australia, Tasmanian pathologists will be hosting a breakfast in Hobart to highlight the importance of bowel cancer screening as part of the #justpooit campaign. Attendees will include Parliamentary MPs, the Hobart Lord Mayor and the CEO of Cancer Council Tasmania. The event will bring together bowel cancer survivors and experts to discuss the effectiveness of bowel screening in preventing deaths through early detection.

Throughout the day, Tasmanians can learn about pathology at various pop-up stalls around the island. Information stalls will be located outside the Royal Hobart Hospital, Launceston General Hospital, North West Regional Hospital, Mersey Community Hospital, Launceston Pathology and Hobart Pathology.

In celebration of International Pathology Day, The Royal College of Pathologists of Australasia (RCPA) will be running a competition for anyone hosting their own event. The competition is open to all hospitals, collection centres, laboratories, medical schools/universities who have signed up to receive RCPA’s free promotional packs. To enter, you can post information and photos of your events directly to RCPA or to RCPA’s Facebook page.

No matter where you live, without pathology workers, there is no medicine. Today, we’d like to say a heartfelt thank you to the hidden heroes of healthcare.

The post Happy International Pathology Day! first appeared on Know Pathology Know Healthcare.

Cancer treatment is highly specialised and many drug treatments are now given based on pathology results that show the drug is likely to be effective. However, this type of testing is limited to specific genes or panels of genes and is ordered when doctors already know some information about the cancer, specifically where in the body it is.

Determining the type or origin of cancer may seem obvious; if cancer is found in the liver, it’s liver cancer right? Unfortunately, that is not always true.

If a person has cancer that spreads to another area of the body (metastasises), the secondary tumour usually has similarities to the original tumour. These similarities in the cells can be seen by a pathologist examining tissue from the tumour under a microscope.

So, when a cancerous tumour is found that does not have characteristics common to cancers from that part of the body, it is usually thought to be a metastasis – cancer that has spread from another cancer elsewhere in the body. When the original site of cancer cannot be identified this is called Cancer of the Unknown Primary (CUP).

Professor Sean Grimmond is Director of the University of Melbourne Centre for Cancer Research at the Victorian Comprehensive Cancer Centre and his research is focused on cancers of unmet need; these are cancers where the survival rate is poor or treatment options are limited. Cancer of the unknown primary falls in this group.

According to Cancer Council Australia, CUP is the fifth most common cause of cancer death in men, and fourth in women.

This means CUP causes more deaths than melanoma or leukaemia.

One reason CUP has a high mortality rate is that it is so difficult to target treatment.

Prof Grimmond says, “In these cases, choosing a drug just based on the tissue of origin can be like guesswork.”

Fortunately, advances in genomic sequencing and scientists’ understanding of cancer DNA are helping to shape new methods for testing and treatment of CUP.

At the VCCC researchers are using genomic sequencing techniques to help patients with difficult to treat cancers.

Prof Grimmond explains: “We want to move from using the microscope for this type of diagnostic to using DNA, because the pattern you see in the DNA can be used to infer the organ of origin.

Also the damage to the DNA in the tumour reflects what type of event triggered the mutation in the DNA that led to cancer developing; whether it’s UV light or smoking or old age. So if you’re looking at a patient that has a cancer of the unknown primary in their pancreas, but you can see a pattern that reflects UV damage, you would start to think that skin could be the origin.”

This research could lead to the development of new specialised pathology tests for CUP patients to help quickly determine the original cause of their cancers, enabling targeted treatment faster.

“This could improve the time to treatment drastically and offer hope for patients where current treatment options are very limited,” says Prof Grimmond.

The post Origin unknown – how pathology is helping to fight mysterious cancers first appeared on Know Pathology Know Healthcare.

In this video, he describes how pathology is central to the vital work to fight cancer, and how high standards in the lab are keeping Australian clinical trials at world- class standards.

The post “Pathology is the art of analysing the tumour” – the role of pathology in cancer clinical trials first appeared on Know Pathology Know Healthcare.

What is Lynch syndrome?

Lynch syndrome is an inherited genetic mutation that means a person has an increased chance of developing certain cancers during their lifetime, often at a younger age than the general population.

The genes in question are mismatch repair (MMR) genes including MLH1, MSH2, MSH6, PMS2, and EPCAM-TACSTD1. These genes are responsible for fixing mistakes made when DNA is copied to prepare for cell division, which is part of the body’s everyday repair and growth mechanism.

Usually a person will inherit two working copies of these genes, one from each parent. People with Lynch syndrome inherit a working copy and a non-working copy.

The defects in the MMR genes mean that copied DNA can contain mistakes – as cells divide, these errors accumulate and uncontrollable cell growth may lead to cancer.

Many cancers are associated with Lynch syndrome, including ovarian, stomach and pancreatic cancer. The most common cancers associated with the condition, however, are bowel cancer and endometrial cancer.

Pathology testing

Lynch syndrome is diagnosed via a blood test. It is an inherited condition and parents with Lynch syndrome have a 50% chance of passing the condition on to their children. Lynch syndrome cannot skip a generation so if a child does not inherit it, they cannot pass it on to their own children.

Risk factors, aside from a family history of Lynch syndrome, is a strong family history of cancer occurring at a younger than normal age such as below age 50. The first step in being tested is to speak to a doctor about your family history of cancer. If appropriate, a doctor will refer patients for genetic counselling and testing.

Lynch Syndrome Australia advises using their “3,2,1 rule” to help people decide if they are at risk:

3 or more family members (including you) have been diagnosed with a Lynch syndrome associated cancer.

2 consecutive generations or more are affected.

1 affected family member is diagnosed with a Lynch syndrome associated cancer before 50 years of age.

Benefits of testing

It is an individual decision whether or not to be tested for Lynch syndrome but a diagnosis can help someone to manage their cancer risk and can potentially help family members.

If deemed at risk, a person will be referred to a specialist service such as a hereditary cancer centre. A genetic counsellor talks through the options and answers any questions to help someone make their decision about getting tested.

If diagnosed, depending on which gene mutation someone has, enhanced monitoring or preventative procedures may be offered. For example, for people with an MLH1 or MSH2 gene mutation, annual colonoscopy is recommended from age 25, or age 30 if the mutation is in the MSH6 or PMS2 gene. For women with a TAH-BSO mutation, hysterectomy and oophorectomy (removing the ovaries) is recommended before the age of 40.

Lynch syndrome can also mean that cancer advances more quickly, so a diagnosis can help someone catch cancer earlier giving a better chance of successful treatment.

As people with Lynch syndrome are more susceptible to cancer at a younger age, a diagnosis can affect some life decisions, in particular for women of child-bearing age.

Lynch Syndrome Australia is committed to raising awareness about the condition so that early diagnosis can help people be better informed and make choices about their health and their future.

The post Little-known Lynch Syndrome increases cancer risk for thousands of Australians first appeared on Know Pathology Know Healthcare.

Multiple myeloma is a form of blood cancer that currently has no cure. It can be treated but the cancer will return – even with the most state-of-the-art treatment. The cancer targets plasma cells and then invades the bone marrow, where the cancerous plasma cells crowd out healthy blood cells. This in turn can lead to other serious health problems including kidney damage and increased likelihood of infection.

The research team, led by the university’s Carbone Cancer Centre but including another 14 cancer research centres, is hoping to change this by conducting the first large-scale trial of a ‘personalized vaccine’ to fight tumors.

The trial will use a patient’s own immune cells combined with their tumor cells to fight the cancer and stop it from recurring. Dr Natalie Callander, head of the trial at UW Carbone, said;

“We’re trying to train the immune system to be constantly surveying to identify and wipe out the re-emerging cancer cells.’’

The team will collect the cancer cells from participating patients and freeze them. Once the patient has undergone chemotherapy to reduce the cancer, their cancer cells will be fused with their own blood cells. The researchers hope that this will generate an immune response which can fight the tumor as quickly as it appears. Dr Callander added;

“This trial is taking personalized medicine to the next level, by making a vaccine from the patient’s own tumors.’’

For more details you can read Dr Callander’s full statement.

The post Personalized medicine on a whole new level for mutliple myeloma first appeared on Know Pathology Know Healthcare.

The tragedy of bowel cancer deaths is that the condition has incredibly good outcomes if it is detected and treated early. It is Australia’s second biggest cancer killer yet 90% of cases can be treated successfully if detected early. This figure decreases to just 15% for stage-four diagnoses.

Detection is heavily reliant on pathology, which is essential both for faecal screening tests and to identify cancerous polyps on biopsy. In fact, every case of cancer is diagnosed by pathology.

The report also states that 30 Victorians a day died from cancer last year and obesity was a major risk factor. Over 1,000 of the new cancers diagnosed last year in Victoria were obesity related, which means an opportunity exists to intervene.

Cancer Council of Victoria CEO Todd Harper said bowel cancer was one of the cancers that people could reduce their risk factors for if they made lifestyle changes;

“It’s important for people to maintain a healthy body weight, be physically active and also eat a healthy diet. Reducing alcohol consumption is also important.”

Mr Harper also said more people need to participate in free screenings. Currently only around 38% of eligible Victorians are participating in the bowel screening program, which is available to everyone aged over 50. This could be due to people being put off by the test.

“I think we need to get across to people that this is a simple test that can save your life,” he said.

The post “A simple test can save your life”: bowel cancer still second biggest cancer killer first appeared on Know Pathology Know Healthcare.