Achieving world-class cancer outcomes


The Royal College of Radiologists (RCR) has published Turning the ambition into action How the Cancer Strategy 2015–2020 can be implemented. This report by the college is a response for action to implement the English Cancer Strategy 2015-2020 published in July 2015. The RCR sets out what it can do to help deliver the strategy and explains where immediate action is required by the Government and health bodies. The College warns that without such action the strategy will rapidly become unachievable and patients will continue to suffer from late diagnosis and delayed treatment.

Understanding cervical screening non-attendance among ethnic minority women in England

British Journal of Cancer (2015) 113, 833–839


Women from Black, Asian and Minority Ethnic (BAME) backgrounds are less likely to attend cervical screening than White British women. This study explored sociodemographic and attitudinal correlates of cervical screening non-attendance among BAME women.

Women (30–60 years) were recruited from Indian, Pakistani, Bangladeshi, Caribbean, African and White British backgrounds (n=720). Participants completed structured interviews.

BAME women were more likely to be non-attenders than white British women (44–71% vs 12%) and fell into two groups: the disengaged and the overdue. Migrating to the United Kingdom, speaking a language other than English and low education level were associated with being disengaged. Being overdue was associated with older age. Three attitudinal barriers were associated with being overdue for screening among BAME women: low perceived risk of cervical cancer due to sexual inactivity, belief that screening is unnecessary without symptoms and difficulty finding an appointment that fits in with other commitments.

BAME non-attenders appear to fall into two groups, and interventions for these groups may need to be targeted and tailored accordingly. It is important to ensure that BAME women understand cancer screening is intended for asymptomatic women and those who have ceased sexual activity may still be at risk.

via British Journal of Cancer – Understanding cervical screening non-attendance among ethnic minority women in England.

Pre-existing diabetes and breast cancer prognosis among elderly women

British Journal of Cancer 113, 827-832 (01 September 2015)


The objective of this study was to assess the impact of pre-existing diabetes on breast cancer prognosis.


Women (n=2833) with centrally confirmed invasive breast cancer in the Women’s Health Initiative, who were linked to Medicare claims data (CMS) were followed from the date of breast cancer diagnosis to date of death or 20 September 2013. Information on diabetes was identified through the CMS Chronic Condition Warehouse algorithm. Cox proportional hazard regression was used to estimate adjusted hazard ratios for overall mortality. A competing risks model (proportional subdistribution) model was used to estimate hazard ratios for breast cancer-specific mortality.


Women with diabetes were more likely to have factors related to delayed diagnosis (less recent mammograms, and more advanced cancer stage) and were less likely to receive radiation therapy. Compared with women without diabetes, women with diabetes had significantly increased risk of overall mortality (HR=1.57, 95% CI: 1.23–2.01) and had nonsignificantly increased risk for breast cancer-specific mortality (HR=1.36, 95% CI: 0.86–2.15) before adjustment for factors related to delayed diagnosis and treatment. Adjustment for these factors resulted in a little change in the association of diabetes with overall mortality risk, but further attenuated the point estimate for breast cancer-specific mortality.


Our study provides additional evidence that pre-existing diabetes increases the risk of total mortality among women with breast cancer. Very large studies with data on breast cancer risk factors, screening and diagnostic delays, treatment choices, and the biological influence of diabetes on breast cancer will be needed to determine whether diabetes also increases the risk for breast cancer-specific mortality.

via Access : Pre-existing diabetes and breast cancer prognosis among elderly women : British Journal of Cancer.

Coffee, tea, caffeine intake, and the risk of cancer in the PLCO cohort

British Journal of Cancer: 113, 809-816 (01 September 2015)



The association between coffee intake, tea intake and cancer has been extensively studied, but associations are not established for many cancers. Previous studies are not consistent on whether caffeine may be the source of possible associations between coffee and cancer risk.


In the Prostate, Lung, Colorectal, and Ovarian cancer screening trial, of the 97 334 eligible individuals, 10 399 developed cancer. Cancers included were 145 head and neck, 99 oesophageal, 136 stomach, 1137 lung, 1703 breast, 257 endometrial, 162 ovarian, 3037 prostate, 318 kidney, 398 bladder, 103 gliomas, and 106 thyroid.


Mean coffee intake was higher in lower education groups, among current smokers, among heavier and longer duration smokers, and among heavier alcohol drinkers. Coffee intake was not associated with the risk of all cancers combined (RR=1.00, 95% confidence interval (CI)=0.96–1.05), whereas tea drinking was associated with a decreased risk of cancer overall (RR=0.95, 95% CI=0.94–0.96 for 1+ cups per day vs <1 cup per day). For endometrial cancer, a decreased risk was observed for coffee intake (RR=0.69, 95% CI=0,52–0.91 for greater than or equal to2 cups per day). Caffeine intake was not associated with cancer risk in a dose–response manner.


We observed a decreased risk of endometrial cancer for coffee intake, and a decreased risk of cancer overall with tea intake.

via Access : Coffee, tea, caffeine intake, and the risk of cancer in the PLCO cohort : British Journal of Cancer.

Recurrent antibiotic exposure may promote cancer formation – Another step in understanding the role of the human microbiota?

European Journal of Cancer: DOI:

Bacterial dysbiosis was previously described in human malignancies. In a recent animal model, tumour susceptibility was transmitted using faecal transplantation. Our aim was to evaluate possible association between antibiotic exposure and cancer risk.

We conducted nested case–control studies for 15 common malignancies using a large population-based electronic medical record database. Cases were defined as those with any medical code for the specific malignancy. Individuals with familial cancer syndromes were excluded. For every case, four eligible controls matched on age, sex, practice site and duration of follow-up before index-date were selected using incidence-density sampling. Exposure of interest was antibiotic therapy >1 year before index-date. Adjusted odds-ratios (AORs) and 95% confidence intervals (CIs) were estimated for each antibiotic type using conditional logistic regression.

125,441 cases and 490,510 matched controls were analysed. For gastro-intestinal malignancies, the use of penicillin was associated with an elevated risk of oesophageal, gastric and pancreatic cancers. The association increased with the number of antibiotic courses and reached 1.4 for gastric cancers associated with >5 courses of penicillin (95% CI 1.2–1.8). Lung cancer risk increased with the use of penicillin, cephalosporins, or macrolides (AOR for >5 courses of penicillin: 1.4 95% CI 1.3–1.6). The risk of prostate cancer increased modestly with the use of penicillin, quinolones, sulphonamides and tetracyclines. The risk of breast cancer was modestly associated with exposure to sulphonamides. There was no association between the use of anti-virals and anti-fungals and cancer risk.

Recurrent exposure to certain antibiotics may be associated with cancer risk in specific organ sites.

via Recurrent antibiotic exposure may promote cancer formation – Another step in understanding the role of the human microbiota? – European Journal of Cancer.