The slippery slide into Christmas

I was going to regale you with our bad weather journey saga but having listened to my colleagues it barely rates. Six and seven hour journeys home seem to be the norm. The biggest complaint isn’t the weather, the lack of gritters or snow ploughs – but poor information.

My tips for the next time are:

1. If you are in or around London – listen to LBC 97.3. While Transport for London is telling everyone stories about bus services running, listeners were calling in with information about where they weren’t running. My personal story is on Monday evening between the Hampstead Pond and Kenwood there were eight buses dark and abandoned on the side of the road in both directions. Cars were having difficulty passing so buses certainly couldn’t.
   
2. Black ice doesn’t mean ice that is black – it means you can’t see it. I decided that the roads were clear enough this morning and drove in – the stretch after Kenwood looked perfectly clear until I saw a few cars stationary ahead so braked and even at just over 10 mph went into a skid. Fortunately nothing around me so all was well. The stationary cars were crashed into each other and the side of the road – cautionary tale.
   
3. Pedestrians – the pavements are rubbish so we walk in the road. If you are doing this and see a car coming – get out of the way – they might brake and then slide not so gently into you – couple of lucky misses spotted. If you are at a pedestrian crossing, wait until the cars have stopped – see (2) above. (P.S. – walk pigeon-toed it stops you sliding forward).
   
4. Cyclists – are you mad?
   
5. Motorists – a new suggestion to add to the shovel and bag of salt. A couple of old towels – if all else fails you can put them under the front wheels for traction. Thanks Colin’s Dad. (P.S. accelerating hard means that your wheels spin faster – you still don’t move!)
   
6. Brickbats only for the various transport services that have not only let people down, some of which was beyond anyone’s reasonable control, but then gave poor information. Telling people to stay home actually isn’t sufficient information.
   
7. Bouquets for the men who left their car at the bottom of Brim Hill and walked up the hill to push the cars spinning their wheels at the top onto the flat and then walked back down and told everyone to wait until the hill was clear so that they could go up in one go without stopping.
   

Number One Daughter is en route from Switzerland by car – with snow tyres and shovel – oh yes and husband and children. They are staying tonight in France and coming through Eurotunnel tomorrow. Tense times – hopefully all will go well. I have enough food for a siege; have been through the stressed, bad-tempered, bah humbug phase and now let the cooking begin.

If you celebrated Chanukah – hope it was a good one and if you are celebrating Christmas I hope that it is a peaceful one. My wish for everyone is that 2010 is happy, healthy and – please – prosperous!

Take home thoughts from San Antonio

It takes a while to digest all the information from such a huge conference but one theme which was common to many of the presentations was the move towards customising the treatment to the patient’s particular tumour. (We tend to think of breast cancer as one disease – it isn’t – it is a group of diseases which appear in one part of the body).

Of course this is good news for patients but we will need extensive and accurate diagnostic tests with definitive biomarkers¹ so that the most effective treatment can be planned for each patient. In addition we will reduce the number of treatments patients have to undergo because we will know which will work and which won’t.

Treatments will be devised for smaller sub-groups of patients – the challenge is how we find sufficient patients to do research. The average breast unit might only see a few of each in a year? Initiatives such as the Breast International Group (BIG) based in Brussels are working to bring together sufficient numbers of patients into clinical trials worldwide and they have been successful in recruiting over 70,000 patients including many thousands in the UK.

However, even before research gets to that stage there is a considerable amount of work that needs to be done in the laboratory and there the challenge is to accumulate sufficient breast cancer tissue from these subgroups to enable this. Access to good quality tissue was identified by Breast Cancer Campaign’s gap analysis which was published last year and will be addressed by Breast Cancer Campaign’s Tissue Bank which will be launched next year.

It is always exciting to see one of our scientists presenting in front of the 8,000 strong crowd at San Antonio (and seeing our jigsaw logo in its full glory on nine giant screens). This year was no exception when Dr Charlotte Coles presented her interim results on an important radiotherapy trial which we supported in Cambridge. Although early work, these results are very promising and we look forward to seeing the outcomes in the future as they track the patients who took part.

A final thought – at some point at every conference a scientist starts to talk about patients failing the treatment. Patients don’t fail treatments – treatments fail patients and targeted treatments will help to stop this.

¹A biological molecule found in blood, other body fluids, or tissues that is a sign of a normal or abnormal process, or of a condition or disease. A biomarker may be used to see how well the body responds to a treatment for a disease or condition.

Keep taking the tablets...

Three and a half days of presentations about breast cancer with hundreds of posters to look at is pretty intense: as a non-scientist I am always interested in ideas which float above the scientific analysis – my scientific colleagues can deal with the clever stuff. (Read the press releases which we issued about some of the presentations).

I also look for links to research that Breast Cancer Campaign is supporting and there are a number which shows that our research is indeed cutting edge.

One presentation which caught my attention was from British Columbia in Canada and relates to the title of this blog. It is counter-intuitive that patients should stop taking medication which is life-saving, but they do. The background is that guidelines for the care of patients with early breast cancer suggest patients should be offered additional treatments after surgery to increase their chances of survival. The principal treatment for women with oestrogen receptor (ER) positive breast cancer over the last three decades has been tamoxifen and more recently, the aromatase inhibitors.

This Canadian study looked at tamoxifen and why it is of interest to us in the UK is that it was publicly funded (as with the NHS); easily available, even to patients in rural areas, and they could track prescriptions. Despite this, they found that 40 per cent of patients took their medicine for less than 80 per cent of the days or even stopped altogether. This has cropped up in several other studies as well.

This particularly caught my attention as we started to fund a two-year project in Dundee earlier this year which will be looking at exactly this problem but expanding it to include aromatase inhibitors. They will identify which of the patients did not take their treatment as prescribed and study what effect this has had on their breast cancer returning and survival.

Identifying the barriers that prevent patients from completing their treatment courses will allow researchers to develop interventions to persuade patients at the beginning of treatment to continue to take their medication as prescribed to ensure maximum benefit is gained. Breast Cancer Campaign is committed to funding research that will lead to improvements in patient survival. We have every confidence that this project will provide essential information to help us to ensure survival rates keep improving and be able to share that information with colleagues around the world.

Hard Times but no Great Expectations

I have attended a number of these conferences in the USA over the years and they are usually awash with freebies. Firstly there is the obligatory conference satchel loaded with all the documentation – and I mean loaded as they weigh a ton. This year it is a canvas one but there are two items missing – the bottle of water and the pen. Happily the bottle of water has been replaced with an empty water bottle which can be filled from the water cooler – yay for the environment.

The second omission is stranger – there is no pen. Now a ball point pen doesn’t cost very much – why not? For those who didn’t bring pens or whose pens ran out there was a rush to the trade exhibition where the only pens seemed to be from the not-for-profits. Normally every stand is competing for the best give-aways –tote bags, memory sticks, stress balls (those foam things you squeeze to calm down!) loads of sweets and chocolates, muffins, coffee – the list is endless. This year there were two stands which had free pens and a couple with chocolates and that was that. If ever there was an indicator that economies are being made – this is it.

The exhibitors are not only from the pharmaceutical industry but also the voluntary organizations and it is always rewarding to swap ideas with our sisters in the USA.

There were just as many delegates – over 8,000 – just the companies cutting back. It is quite cost-effective for us to attend – we always get sponsorship but book our own trip – our hotel (or should it be motel) is cheaper than Travel Lodge but everything works and is clean but for some strange reason there is no plug in the basin – they don’t provide them. No meals included ,but happily loads of free food at the conference.

The day ended with a stunning presentation by another British scientist – we do punch above our weight. Tomorrow starts with posters at 7.00 ……..

Will we be able to prevent breast cancer?

Writing from the San Antonio Breast Cancer Symposium – the opening address was by a distinguished UK scientist, Professor Valerie Beral giving an epidemiological perspective on the causes and prevention of breast cancer.

Her conclusions were deceptively simple. Women who have many children, have them young and breast feed them for long periods of time have a much lower risk of breast cancer. Late pregnancy (miscarriages and abortions have no effect) and breast feeding produce changes in the body which persist indefinitely. This is interesting because while HRT and the contraceptive pill have been shown to produce a slight increase in the incidence of breast cancer once you stop taking them the increased risk goes away until a few years on there is absolutely no increased risk.

Her conclusions are stark – few women in developed countries are at really low risk of breast cancer unless they develop the birth and breast feeding patterns of women in rural developing countries. Clearly that is not going to happen- you can and should certainly breast feed if you have children but are not going to have any or many children simply to reduce our risk.

Another conclusion is that with the gradual urbanization of developing countries and the impact that has on family size, by 2030 we could see the number of breast cancers diagnosed annually worldwide double from one to two million.

There are factors which we can change: if no woman in the USA was obese, drank alcohol or used the pill or HRT there would be 40,000 fewer cases of breast cancer (140,000 against 180,000).

I think this is scientifically interesting and really does point to avenues for research – prevention is the most difficult and expensive avenue of research. But, as Valerie acknowledged, none of this is very helpful to us now – altering childbearing patterns is not a realistic option so interventions which mimic the effects of childbearing and lactation are needed.

Just remember – lies, damn lies and statistics – this is about statistics and it doesn’t mean that no woman who has children and breast feeds will get breast cancer and not all nuns get breast cancer either – I am not being facetious about nuns – the start of this research was an observation in the 18th century that nuns had a much higher risk of breast cancer than married women. That is the basis of epidemiology – scientific observation of what has happened so that you can change what will happen.

Call me old-fashioned……

Thanks to my jolly electric car I don’t often use the underground in the rush hour. This week my car is being serviced so there I was standing on the train ( a seat? Unlikely) and letting the mind wander when I noticed that two women in the row I was facing were putting on make-up. I don’t mean a bit of lippy and a dash of blusher but the full war-paint.

One finished quite quickly but the other one did a job worthy of Strictly Come Dancing without the fake tan. I have no idea if she moisturized and toned before I boarded – but given the thoroughness of the rest she must have. A very careful foundation – blusher, shaper and then the whole nine yards with her eyes. Three coats of mascara, separating the lashes in between with a little metal comb – that took two tube stops to accomplish. Even a few stray hairs were tweezed and I suppose we should count ourselves lucky that she didn’t feel the need to shave her legs as well. This process had already begun when I joined the train and took almost to Old Street to accomplish.

It is not that I don’t use make-up, or watch others do it but somehow this young woman sitting on a crowded train, oblivious to everyone (lucky her) was weirdly compelling. And what a bag of stuff she had – a plethora of brushes, tubes, pencils, jars and bits of coloured stuff – my shoulder was aching at the thought of lugging that around.

I write this in another confined space, on my way to San Antonio to the largest breast cancer research conference in the world - usually around 8,000 delegates and the main lecture hall is like an aircraft hangar with large screens everywhere – if you are at the back you actually cannot see the speaker in the flesh so to speak.

It is a fantastic chance to catch up with what is happening in the field, meet up with many of our scientists, always a few presenting their work – the Brits are usually the second largest national group presenting after the Americans . One wonders in the current economic mess we are in how science will fare in the UK and whether the infrastructure will be there so that we can support great brains to do great research. The science we fund today means lives saved tomorrow – can government take that leap of faith?

Stupid, stupid – you have been warned

I thought I was the most paranoid person about security – multiple passwords, code words, suspecting everyone and yet one lapse and the fraudsters are on the case.

Last month Number One daughter came for a visit and we had a girls day shopping and lunch. There was this very nice restaurant and their Amex (American Express) machine wasn’t working. So I went to the counter while they phoned Amex and then gave Amex all my details – not something I would normally do but I was momentarily distracted. This included my mother’s maiden name. I thought nothing more of it and I check my statement online regularly and everything was in order.

I received a call from them last Friday to ask if I had put through an online transaction for gift vouchers for £3,000*. I have never spent that much – or even close to that much in one transaction so it wasn’t me. They immediately cancelled the card.

I then received a call yesterday from the fraud department to go through various transactions and the first one they asked about was the restaurant and if there was anything unusual about it. Ping!!

Apparently the scam is that the fraudster writes on what looks like Amex paper to the restaurant (targeting London apparently), tells them their system will be down at a certain time and asks them to call a specific number to process the transaction, which of course is the fraudster’s. The fraudster can then contact Amex with the information for the transaction but has all your personal information too. Unsuspecting restaurant and customer........ Amex is communicating this to the restaurants and me to you!

If this should happen and a trader should ask you to speak to the card issuer on the phone – insist on calling the number on your card. Do not give any information if they just hand the phone to you.

*This particular crook pre-warned Amex that the large transaction was coming through online so that it wouldn’t be blocked and has set up a new telephone number and also advised of a change of address. Hope they get her!

Another strange thing happened a couple of weeks ago – I had a letter from Santander saying that someone purporting to be me had applied for credit and they were confirming this was actually me. I called them immediately – they had no further information as it was online but it is obviously related to the incident above.

Amex has been great but I am incandescent with rage with myself – just one slip....

Both Amex and Santander have tagged me at CIFAS so that if anyone tries to obtain, say, a new credit card, even if it is me, they will require further identification. CIFAS is a not-for-profit fraud prevention data sharing scheme.