Breaking the link

Years of research have transformed our understanding of cancer and have led to new treatments and big improvements in survival rates.

But still lives are being lost, particularly in poorer areas where cancer rates are much higher than more wealthy parts of the country.

So why is there a difference and what can be done about it?

‘As big as a pea’

Michael Brady has lived almost all his 65 years in Harpurhey, a traditionally working class part of Manchester.

Michael made his living mostly in the building trade and, like many of the men he worked with, enjoyed a drink and a smoke.

A few years ago he developed the lung condition COPD (chronic obstructive pulmonary disease), which at times makes it difficult to breathe.

And on Tuesday last week, Michael was also diagnosed with lung cancer.

“It’s a very small one, about as big as a pea,” Michael said, describing the tumour that was found on his right lung.

“If it had gone on any longer, it possibly wouldn’t have been curable, but I think, 99% in my own mind, it’s curable.

“I’m not stressed about it, I’m just carrying my life on as normal.

“I don’t go to bed thinking about it, I don’t get up thinking about it like a lot of people do, because I’ve had quite a few friends in the past that have had cancer and died through it.”

Hard to detect

And perhaps that is not surprising given that Manchester – Michael’s home town – has the highest number of premature deaths because of lung cancer in England.

Overall cancer rates in Manchester, with some of the most deprived boroughs in England, are also significantly higher than average.

1st

for deaths from cancer

1st

for deaths from heart disease

• 2nd for deaths from strokes

• 2nd for deaths from lung disease

• 4th for deaths from liver disease

Many of those cancers are linked to lifestyle – smoking, eating and drinking. And on that basis, more than four out of 10 cancers could be prevented.

Lung cancer presents a particular challenge in that it is often very hard to detect until it is too late.

In more deprived communities, this is – in part – because so many of those at greatest risk of lung cancer already have other health conditions, like Michael with his COPD.

These can sometimes mask the symptoms of the cancer, leading to a later diagnosis.

Opportunity ‘to save lives’

So how does the NHS try to reach people in poorer communities with whom it has been harder to connect?

One answer is to bring healthcare to them, rather than expect them to come and seek help.

South of the city in Wythenshawe, just outside the Forum shopping centre, a mobile scanner is offering those most at risk a screening for lung cancer.

This is how Michael’s cancer was picked up at such an early stage.

Inside the scanner – a large white lorry trailer – a small team of medical staff is seeing a steady stream of patients.

One of those is Elaine Walker, who was given the all-clear.

But Elaine lost her husband to lung cancer and her grief is still raw, so she knows how important these scans can be.

“I just wish people would take notice and have this done, because if they’ve not been through what I’ve been through, they’re silly if they don’t have it done, that’s all I can say.

“It’s an opportunity for people to save their lives.”

Lung specialist Dr Richard Booton is overseeing the project and he is convinced this approach helps reach those poorer communities where cancer claims the most lives.

Choices and chances

“If you look at uptake here, for those who’ve rung for an appointment we’re in the 90%-plus of people attending for their screening scan.

“It’s more convenient, isn’t it? We’re right outside a shopping centre, you can pop down and do your shopping and your appointment is the same day, you can access it in 20 minutes, you’re done.”

He adds: “This allows a disadvantaged area to access important screening technology in their everyday lives.

“Hopefully for the vast majority that will be the end of it, there will be no need to visit hospitals, but for a select few they’ll need to come and see us and have some abnormalities clarified.”

But why is cancer, in particular, such a big killer in Manchester?

Prof Sir Michael Marmot of University College London is one of the world’s leading experts on health inequalities.

He suggests the answer lies not just in the choices people make, but also the chances that life offers them.

Meaningful activity – a fulfilling job for example – can greatly improve the odds of a healthier life.

“It means you’re more likely to make the healthy choices, more likely to eat healthily, not smoke, be physically active, control your weight and the like,” he said.

“The other reason is it relates to the body’s stress pathways; deprive people of control, that’s a more stressful situation.

“Control – empowerment – is absolutely key.”

Prof Marmot added: “When people are disempowered, when they feel they don’t control their lives, why should they bother making the healthier choices such as non-smoking and healthy eating?”

More people than ever before are surviving cancer thanks to better treatments, but the next big battle is preventing them from developing the disease in the first place.

And the answer to that may lie not just in scientific discovery, but also in improving our economic prospects.