- Email: [email protected]
Failure to improve cancer services in the UK
News
Exposure to passive smoke among never smokers does not seem to increase the chances of acquiring somatic mutations in genes linked to non-small-cell lung cancer in smokers, a new study shows. The authors explored how passive smoking affected the pattern of somatic mutations in people who had never smoked and had lung cancer, explains lead author Sébastien Couraud (Hospices Civils de Lyon, Lyon, France). Mutations in the EGFR and HER2 genes have been previously linked to non-small-cell lung cancer in people who have never smoked, whereas KRAS, BRAF, and PIK3CA mutations have been observed in people who do smoke. However, there is still debate about whether passive smoke affects the mutational pattern of these genes in people who have never smoked.
Of a cohort of 319 patients, 219 (66%) reported previous exposure to passive smoking. In this group, no significant differences were found in the mutation pattern of lung cancer oncogenes, compared with people who did smoke (EGFR mutation: 46% vs 41%; KRAS: 7% vs 7%; ALK: 13% vs 11%; HER2: 4% versus 5%; BRAF: 6% vs 5%; PIK3CA: 4% vs 2%). “To have been exposed to passive smoking (either during childhood or during adulthood only) does not modify the somatic profile. Indeed, our first hypothesis was that been exposed to passive smoke may have induced [a] ‘smoker-like’ somatic profile. This hypothesis was not supported”, explains Couraud. The findings serve as a cautionary tale for physicians not to use passive smoking exposure to deduce somatic
mutation profiles, warns Couraud. “Patients who have been exposed to passive smoke have the same chance to carry an EGFR mutation than other never-smokers”, he adds. However, a likely caveat of this study concerns the small number of mutations identified, says Kirsti Husgafvel-Pursiainen (Finnish Institute of Occupational Health Helsinki, Finland). Also, results of a previous study showed that the mutations identified in these lung cancer oncogenes were not common in people who smoke, she says. “One may ask whether these gene mutations comprise a biomarker well suited for investigating tobaccosmoke exposure-related mutations in a study setup, which involves lowlevel exposure.”
Ian Boddy/Science Photo Library
Mutation patterns in lung cancer never-smokers
Published Online March 20, 2015 http://dx.doi.org/10.1016/ S1470-2045(15)70132-4 This online publication has been corrected. The corrected version first appeared at thelancet.com/ oncology on March 25, 2015 For the study by Couraud and colleagues see Eur Respir J 2015; published online March 5. DOI: 10.1183/09031936.00097314
Karl Gruber
Failure to improve cancer services in the UK A parliamentary select committee has raised concerns over cancer care in England. “The Department of Health and NHS England have lost momentum in the last two years”, stated the Commons Public Accounts Committee. “The incidence of cancer has grown whilst the resources available to support improvement have [been] reduced. Leadership has been lost [and] the support for commissioners and providers to support improvement reduced”. The authors of the report warned that straitened resources and changes to the health-care system could stall the improvements seen over the last decade. The chair of the committee, Labour’s Margaret Hodge, complained of an “unacceptable and unexplained variation in the performance of cancer services across the country”. She criticised NHS England for failing
www.thelancet.com/oncology Vol 16 April 2015
to identify what lay behind regional variations. “Things are in danger of reaching breaking point; there are going to be one-third more cancer cases over the next 15 years, and we are not going to deliver continued improvements unless we properly resource and properly plan”, comments Sarah Woolnough (Cancer Research UK, London, UK), who gave evidence to the committee. She is concerned that the absorption of the 28 Cancer Networks into the 12 Strategic Clinical Networks, the abolition of the National Cancer Action Team, and the move from a full-time role to a parttime one for the National Clinical Director for Cancer, have caused a loss of direction and planning capacity. The parliamentary committee noted that “focus on cancer has also been diluted at a local level”. For the first three-quarters of 2014, NHS England
did not meet its target of initiating treatment for 85% of patients with cancer within 62 days of referral. “Missed waiting-time targets is an indicator that a system is struggling”, Woolnough points out. A spokesperson for the Department of Health countered that “cancer survival rates are now at their highest ever level [and] we have invested an extra £750 million on cancer services, including early diagnosis”. 20% of cancer patients in England are diagnosed upon emergency presentation. “NHS England has announced a new independent Cancer Taskforce to develop a 5-year action plan for cancer services that will improve survival rates”, adds the spokesperson. At present, 5-year survival rates in England are about 10% lower than the European average.
Published Online March 20, 2015 http://dx.doi.org/10.1016/ S1470-2045(15)70133-6 For the report on progress in improving cancer services and outcomes in England see http:// www.publications.parliament. uk/pa/cm201415/cmselect/ cmpubacc/894/89402.htm
Talha Khan Burki
e163
Exposure to passive smoke among never smokers does not seem to increase the chances of acquiring somatic mutations in genes linked to non-small-cell lung cancer in smokers, a new study shows. The authors explored how passive smoking affected the pattern of somatic mutations in people who had never smoked and had lung cancer, explains lead author Sébastien Couraud (Hospices Civils de Lyon, Lyon, France). Mutations in the EGFR and HER2 genes have been previously linked to non-small-cell lung cancer in people who have never smoked, whereas KRAS, BRAF, and PIK3CA mutations have been observed in people who do smoke. However, there is still debate about whether passive smoke affects the mutational pattern of these genes in people who have never smoked.
Of a cohort of 319 patients, 219 (66%) reported previous exposure to passive smoking. In this group, no significant differences were found in the mutation pattern of lung cancer oncogenes, compared with people who did smoke (EGFR mutation: 46% vs 41%; KRAS: 7% vs 7%; ALK: 13% vs 11%; HER2: 4% versus 5%; BRAF: 6% vs 5%; PIK3CA: 4% vs 2%). “To have been exposed to passive smoking (either during childhood or during adulthood only) does not modify the somatic profile. Indeed, our first hypothesis was that been exposed to passive smoke may have induced [a] ‘smoker-like’ somatic profile. This hypothesis was not supported”, explains Couraud. The findings serve as a cautionary tale for physicians not to use passive smoking exposure to deduce somatic
mutation profiles, warns Couraud. “Patients who have been exposed to passive smoke have the same chance to carry an EGFR mutation than other never-smokers”, he adds. However, a likely caveat of this study concerns the small number of mutations identified, says Kirsti Husgafvel-Pursiainen (Finnish Institute of Occupational Health Helsinki, Finland). Also, results of a previous study showed that the mutations identified in these lung cancer oncogenes were not common in people who smoke, she says. “One may ask whether these gene mutations comprise a biomarker well suited for investigating tobaccosmoke exposure-related mutations in a study setup, which involves lowlevel exposure.”
Ian Boddy/Science Photo Library
Mutation patterns in lung cancer never-smokers
Published Online March 20, 2015 http://dx.doi.org/10.1016/ S1470-2045(15)70132-4 This online publication has been corrected. The corrected version first appeared at thelancet.com/ oncology on March 25, 2015 For the study by Couraud and colleagues see Eur Respir J 2015; published online March 5. DOI: 10.1183/09031936.00097314
Karl Gruber
Failure to improve cancer services in the UK A parliamentary select committee has raised concerns over cancer care in England. “The Department of Health and NHS England have lost momentum in the last two years”, stated the Commons Public Accounts Committee. “The incidence of cancer has grown whilst the resources available to support improvement have [been] reduced. Leadership has been lost [and] the support for commissioners and providers to support improvement reduced”. The authors of the report warned that straitened resources and changes to the health-care system could stall the improvements seen over the last decade. The chair of the committee, Labour’s Margaret Hodge, complained of an “unacceptable and unexplained variation in the performance of cancer services across the country”. She criticised NHS England for failing
www.thelancet.com/oncology Vol 16 April 2015
to identify what lay behind regional variations. “Things are in danger of reaching breaking point; there are going to be one-third more cancer cases over the next 15 years, and we are not going to deliver continued improvements unless we properly resource and properly plan”, comments Sarah Woolnough (Cancer Research UK, London, UK), who gave evidence to the committee. She is concerned that the absorption of the 28 Cancer Networks into the 12 Strategic Clinical Networks, the abolition of the National Cancer Action Team, and the move from a full-time role to a parttime one for the National Clinical Director for Cancer, have caused a loss of direction and planning capacity. The parliamentary committee noted that “focus on cancer has also been diluted at a local level”. For the first three-quarters of 2014, NHS England
did not meet its target of initiating treatment for 85% of patients with cancer within 62 days of referral. “Missed waiting-time targets is an indicator that a system is struggling”, Woolnough points out. A spokesperson for the Department of Health countered that “cancer survival rates are now at their highest ever level [and] we have invested an extra £750 million on cancer services, including early diagnosis”. 20% of cancer patients in England are diagnosed upon emergency presentation. “NHS England has announced a new independent Cancer Taskforce to develop a 5-year action plan for cancer services that will improve survival rates”, adds the spokesperson. At present, 5-year survival rates in England are about 10% lower than the European average.
Published Online March 20, 2015 http://dx.doi.org/10.1016/ S1470-2045(15)70133-6 For the report on progress in improving cancer services and outcomes in England see http:// www.publications.parliament. uk/pa/cm201415/cmselect/ cmpubacc/894/89402.htm
Talha Khan Burki
e163