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Tuesday, 4 January, 2000, 15:39 GMT
The future of cancer treatment

Chemotherapy like this can cause hair loss and nausea
Highly unpleasant and damaging cancer therapies may be consigned to the history books by huge advances over the next 20 years, say experts.

It is hard to imagine a time in which a diagnosis of cancer would not produce a feeling of terror in a patient.

But scientific breakthroughs are threatening to transform it into the equivalent of high blood pressure - a worrying condition which requires treatment, but which is only occasionally fatal.

A pensioner receiving a cancer diagnosis might well expect to die of old age rather than from the march of the disease.

But equally, patients might have to abandon the concept of total cure and learn to live with their condition.

Long term cancer treatments would be far gentler than those currently used to try to eradicate the illness.

Genetic map

Cancer cells are just like normal ones - with one key difference - they keep on dividing and reproducing instead of dying off.

Scientists are mapping the genetic makeup of cancer cells
Cancer researchers believe they are close unlocking the complete genetic makeup of many common cancers.

By understanding exactly how the rogue cells differ from normal cells, treatments can be modified so they work on just the cancer cells.

Conventional chemotherapy has a scattergun effect - although it kills cancer cells, it can also affect surrounding normal cells, particularly those which have a tendency to divide quickly, such as those in the stomach lining, or the hair follicle.

This is what produces unpleasant side effects such as nausea, and the falling out of hair.

Although chemotherapy has been modified over the years so it targets only cancer cells, cutting the side effects, in the future the treatments could be fine-tuned even further.

Professor Karol Sikora, a leading cancer researcher based at Hammersmith Hospital in London, told BBC News Online: "The future will be long term chronic treatment, perhaps by tablets.

Cancer: cases per 100,000 population - survival rates (%)
Lung 77.5 - 6
Prostate 77.5 - 42
Colorectal 56.4 - 39
Bladder 49.0 - 65
Breast 97.6 - 68
Colorectal 33.0 - 39
Lung 34.7 - 6
Ovary 17.4 - 29
Uterus 11.4 - 73
"It will be control rather than cure, and the NHS will have to adapt, with less expensive hospital beds.

"People will be more willing to travel to get treatment. There could be 20 or so centres in the UK."

At the moment, doctors know about a number of genes which predispose someone towards developing cancer, such as the BRCA1 gene in breast cancer.

However, understanding the complete gene map of cancer will allow doctors to spot early those who are likely to develop the condition.

Professor Sikora said: "When the Human Genome Project comes to fruition, it will give us a tremendous amount of information.

"We will be able to predict high risk people - everyone will have a simple blood test and then we would be able to stop giving mammograms to many women."

Because potential sufferers could be spotted earlier, treatments would have a greater chance of working and controlling the disease.

Eventually, predicts Professor Sikora, people could even be implanted with a "gene chip" which could detect the earliest signs of the genetic mutations that cause cancer.

A patient could check themselves up with a home computer, which could then contact the GP by e-mail to arrange an appointment if something is wrong.

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