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New clinical prediction tools for myeloma

Myeloma is a cancer of the bone marrow that caused 117,077 deaths worldwide in 2020 (International Agency for Research on Cancer). Earlier diagnosis improves the rate of survival but unfortunately, delays in myeloma diagnosis are common and result in poorer patient outcomes.

One of the reasons for the diagnostic delay is that myeloma symptoms are non-specific and relatively common in people without cancer. For example, back pain is associated with myeloma yet there are many other non-myeloma causes of this symptom. Additional measures are therefore needed to highlight the possibility of myeloma in patients where GPs do not originally suspect this disease.

GPs frequently order simple laboratory tests, such as the full blood count, to investigate patients presenting with non-specific symptoms. Previous work by Dr Constantinos Koshiaris, Dr Jason Oke, Dr Brian Nicholson and colleagues from Oxford’s Nuffield Department of Primary Care Health Sciences and the University of Exeter identified certain abnormalities in blood test results that indicate a higher risk of myeloma, such as low haemoglobin which can be observed up to 2 years before a myeloma diagnosis.

In this paper published recently in the British Journal of General Practice, the Oxford researchers have developed new clinical prediction models for myeloma that incorporate both symptoms and blood test results. Using the Clinical Practice Research Datalink (GOLD version), a primary care database containing electronic health records for more than 11 million patients in the UK, the team identified the most common symptoms and full blood count results recorded for patients with myeloma. The most predictive of these were included in the models they developed and the new tools were validated against a set of test data. Decisions made using their prediction models resulted in fewer false positives and more true positives when compared to single tests or symptoms alone.

By identifying patients at highest risk of myeloma in primary care, these new prediction rules have the potential to reduce diagnostic delays by a substantial amount. Further research is now needed to understand more about the feasibility and implementation of this tool in the primary care setting and the impact it will have on the diagnostic pathway and patient outcomes.

Higher testosterone levels in men linked to greater melanoma risk

1 in 36 UK males and one in 47 UK females will be diagnosed with melanoma skin cancer in their lifetime. However, 86% of melanoma cases were preventable, as many cases are caused by UV ray exposure, but other factors can also play a role in who is most at risk, such as age and genetics.

A recent study lead by Dr Eleanor Watts at the Nuffield Department of Population Health has now found that testosterone is one of these risk factors. Published in the International Journal of Cancer, the team found that men with high levels of testosterone have an increased risk of developing a potentially deadly type of skin cancer. This was a result of studying blood samples hormone data. collected by the UK Biobank from 182,600 men and 122,100 postmenopausal women aged 40 to 69.

The researchers looked both the total level of testosterone in the blood samples, as well as levels that were freely circulating. They then used national registries and NHS records to explore whether participants went on to develop or die from cancer.

The results show that by 2015-16, after being followed for an average of seven years, 9,519 men and 5,632 postmenopausal women – 5.2% and 4.6% of participants respectively – had been diagnosed with a malignant cancer. By excluding other, non-melanoma diagnoses and accounting for other factors, they found that for men, higher levels of testosterone, whether freely or in total, were associated with a greater risk of developing malignant melanoma.

Specifically, each 50 pmol/L increase in free testosterone was found to raise the chance of developing this cancer by 35%. 90% of men included in the study had free testosterone concentrations of between 130 pmol/L and 310 pmol/L.

Among other findings, higher levels of freely circulating testosterone were associated with a greater risk of prostate cancer in men, while in post-menopausal women, higher levels of testosterone, whether freely circulating or in total, were associated with a greater chance of endometrial and breast cancer.

Dr Eleanor Watts, the first author of the research from the University of Oxford, says:

“There has been indirect evidence for testosterone and melanoma before, but this is the first time we have been able to look directly at the hormones in the blood

“Although we have seen associations of prostate, breast and endometrial cancer with testosterone before, this is the first time we have seen an association with risk of melanoma in men.”

 

About Eleanor

Eleanor is an Early Career Research Fellow in the Cancer Epidemiology Unit (CEU), part of the Nuffield Department of Population Health. Her research examines the role of endogenous hormones on prostate cancer risk using UK Biobank.

Funding to improve childhood, teenage and young adult cancer detection

Cancer is the commonest cause of death among children and young people in the UK and is associated with significant long-term morbidity. Unfortunately, the UK lags behind other high-income countries in the time it takes to diagnose childhood, teenage and young adult (TYA) cancer and this delay worsens patient outcomes.

One of the challenges in diagnosing childhood and TYA cancer is its relative rarity and non-specific presentation, and awareness campaigns have been run in an effort to improve recognition of cancer signs among health professionals. Although this resulted in improvements for certain types of cancers in children and TYA, the national time-to-diagnosis targets have still not been reached in all cancers for all age groups.

Dr Defne Saatci and Professor Julia Hippisley-Cox (Nuffield Department of Primary Care Health Sciences) have successfully applied for a Cancer Research UK Early Detection and Diagnosis Project Award to accelerate diagnosis of childhood and TYA cancer. They will use the QResearch database, the UK’s largest GP electronic health record database, covering 20% of the UK population and linked to national cancer, hospital and mortality registries. QResearch data will be explored to identify the early symptoms and signs associated with a subsequent diagnosis of the commonest childhood and TYA cancers (acute lymphoblastic leukaemia, lymphomas and central nervous system tumours) and this information will be used to develop a risk prediction tool for GP use.

By increasing the understanding about the clinical features associated with childhood and TYA cancers and developing this risk prediction tool for use in primary care, this study aims to make significant advancements in childhood and TYA cancer diagnosis and outcomes.

If you are an Oxford-based researcher thinking of applying for external early detection funding, please get in touch with the OxCODE Scientific Coordinator who can help to coordinate your application.

 

New partnership enables access to state-of-the-art radiotherapy machine

The first NHS patient has received treatment on the cutting-edge ViewRay MRIdian technology, thanks to a new partnership between the University of Oxford, Oxford University Hospitals (OUH) NHS Foundation Trust and GenesisCare.

The partners, with the support of the John Black Charitable Foundation, have collaborated to establish a ten-year programme of clinical treatment for NHS patients, with further research into improving cancer treatment using the Viewray MRIdian.

Due to the natural, unavoidable movement of soft tissue inside the body, normal tissue around the cancer can be exposed to radiotherapy treatment, particularly when targeting soft-tissue tumours deep within the body. It can be challenging to visualise these organs during radiotherapy with routine radiotherapy delivery.

The ViewRay MRIdian machine is the only one of its kind in the UK, with only 41 machines worldwide. It allows doctors to see the normal soft tissue and the tumour in real time by combining MRI scanning with targeted radiotherapy. Incorporating MRI scans will allow doctors to then tailor doses in real time to the specific internal anatomy of the patient on the day of treatment.

MRIdian technology also minimises the damage to surrounding healthy tissues by switching off when tumour tissue moves outside of the targeted beam. This could mean less side effects for patients and increased dosage of treatment delivered directly to the tumour.

GenesisCare, the University of Oxford and OUH will also partner in research collaborations to develop real-world evidence which will inform future utilisation of the MRIdian technology in hard-to-reach tumours, such as pancreatic cancers. The research partnership will assess the benefits of the MRIdian technology in terms of improved cancer outcomes and reduced toxicity.

Elizabeth Rapple, from South Oxfordshire, is the first patient to use the machine to treat her renal cancer, as part of the new partnership. She says:

“I feel very fortunate to be able to access this machine as part of a new Oxford-wide partnership. Any operation to remove my tumour would have been highly invasive, so it’s lucky that my cancer was suitable for MRIdian radiotherapy. I am so grateful that this unique machine has been made accessible through the NHS, and that I can be the first of many to benefit from this partnership going forward.”

Project leader Professor Tim Maughan, from the University of Oxford, said:

“Treating patients on the MRIdian is like a surgeon putting on their spectacles for an operation – for the first time we can see exactly what the cancer is doing during treatment and adapt to change accordingly.  This accuracy allows us to reduce side effects and we hope to improve cancer outcomes in hard-to-treat cancers.”

Dr James Good, Clinical Oncologist at GenesisCare, said:

“The MRIdian machine is at the cutting-edge of what is possible in radiotherapy technology. The ability to visualise the tumour more accurately, to follow it while it’s being treated and to adapt the plan every day means we can deliver the best possible outcomes.

“This collaboration with the University of Oxford and Oxford University Hospitals will be truly beneficial for cancer patients in the UK. Not only will it provide patients who otherwise would have limited, or sadly, no options with a really viable treatment option, but we can also help demonstrate the effectiveness of this treatment, with the ambition to make it available for all NHS patients in the future.”

Carol Scott, Lead Therapeutic Radiographer & Deputy Clinical Director at Oxford University Hospitals , said:

“OUH are excited to be part of this collaboration offering NHS patients the opportunity to take part in these clinical trials. The use of daily advanced imaging that clearly shows us the tumour and normal soft tissue around it will enable us to take the next step in making our treatments even more personalised and effective”

Drinking alcohol regularly increases cancer risk in Chinese populations

A new study demonstrates that reducing alcohol consumption in China could be an important cancer prevention strategy. Full story on the NDPH website.

For Western populations, there is a well-established association between regular alcohol consumption and a greater risk of various types of cancer. However, it was unknown whether these increased risks were the same for Eastern populations, which have very different drinking patterns and alcohol tolerance. Cancer rates are rising rapidly in China, and this may be partly due to more frequent alcohol consumption as citizens become more affluent. A new study led by NDPH on the large China Kadoorie Biobank has investigated this, with the findings published today in the International Journal of Cancer.

The study assessed over half a million adults recruited across ten diverse regions in China between 2004 and 2008. Each participant was questioned about their drinking habits, then followed up for a median period of 10 years. By the end of the study, almost 27,000 individuals had developed cancer (13,342 men, 13,619 women).

About a third of the men in the study drank regularly (at least once every week). Compared with those who abstained from alcohol, regular drinkers had a 26% higher risk for cancers previously associated with alcohol (ie, mouth/throat, oesophagus, colon-rectum and liver) and a 7% higher risk for all types of cancer. The risks were greater in those who drank daily or drank outside of meals.

For most of the cancers investigated, there was a clear dose-response relationship. Each 280 g/week higher alcohol intake was associated with an increased risk of 98% for oesophageal cancer; 74% for mouth/throat cancer; 52% for liver cancer and 19% for colon-rectum cancer. The study also found that each 280 g/week higher alcohol intake increased the risk of lung cancer (25%) and gallbladder cancer (60%), even though these cancers had not previously been clearly linked with alcohol.

In East Asia, many people cannot metabolise alcohol effectively due to an inherited deficiency in the enzyme aldehyde dehydrogenase 2. This causes the carcinogenic compound acetaldehyde to accumulate, which can lead to facial flushing. In this study, those who experienced flushing after drinking had stronger associations between alcohol intake and cancer risk, particularly for oesophageal and lung cancer. This suggests that the risk of developing cancer is greater for those with low alcohol tolerability.

The associations remained strong when the researchers controlled for potential confounding variables including age, region, education, income, body mass index, physical activity, and fresh fruit intake. The association between alcohol and lung cancer was similar for regular smokers and those who had never smoked regularly. Nevertheless, large-scale genetic studies are needed to determine if the associations between alcohol and cancer are likely to be causal.

Very few women in the study drank alcohol regularly, hence the study was unable to assess whether the association between alcohol and cancer risk was the same for women.

Lead author Dr Pek Kei Im said: ‘Our study has clearly shown that among Chinese men, alcohol consumption is associated with increased risks of several types of cancer, including some that were less clearly established to be alcohol-related previously. This suggests that lowering population levels of alcohol consumption is an important strategy for cancer prevention in China.’

New Oxford technology assesses cancer patient vulnerability to COVID-19

The web-based COVID risk prediction tool, QCovid, is the product of the latest research to emerge from the QResearch database co-founded by Prof Julia Hippisley-Cox based at the University of Oxford. The analysis of anonymised UK health records of more than 8 million adults using GP records, hospital records including intensive care data, mortality data, Cancer Registry data and COVID-19 testing data from late January 2020 to April 2020 allows clinicians to estimate someone’s  risk of COVID-19 infection as well as the risk of being admitted to hospital with serious illness due to the virus and the potential risk of COVID-19-related death. QCovid takes into account a range of risk factors such as age, gender ethnicity and medical conditions and enables the NHS to make evidenced based decisions when prioritising different patient groups for shielding and COVID-19 vaccination.

The work was commission by England’s Chief Medical Officer Chris Whitty, who involved the team led by clinical epidemiologist, Prof Julia Hippisley-Cox, at the University of Oxford as the group has acquired extensive experience in developing risk prediction tools for a range of diseases, including QCancer for the prediction of having  undiagnosed cancer, which are widely used in the NHS. QCovid has now been validated and published in the British Medical Journal, is accessible to the public at www.qcovid.org and has been adopted by NHS Digital as a way to assess the relative risk of COVID-19 for all members of the population, based on their medical history and other risk factors.

Based on the prediction tool, 1.7 million patients have been added to the shielding list, including many cancer patients. Those within the most ‘vulnerable’ group who are over 70 will have already been invited for vaccination and 820,000 adults between 19 and 69 years will now be prioritised for a vaccination.

CANCER & VULNERABILITY

Although previous studies from the University of Oxford have shown that blood cancer patients are at higher risk of COVID-19, until now no research or model had been published that assessed patients with different types of cancer, including their treatment history and backgrounds. The QCovid algorithm feeding into the prediction tool takes cancer factors such as diagnosis of blood, lung, oral or bone cancers and different cancer therapies into account.

Thus using the QCovid prediction tool, it has a been highlighted that those with blood (acute myeloid leukaemia, chronic myeloid leukaemia, acute lymphoblastic leukaemia, chronic lymphocytic leukaemia, Hodgkin lymphoma, non-Hodgkin lymphoma, multiple myeloma) and respiratory (lung, laryngeal, nasopharyngeal and mouth) cancers are at increased COVID-19 risk.

In addition, those undergoing therapy (including recent bone marrow or stem cell transplant, chemotherapy, radiotherapy, immunotherapy or other antibody treatments for cancer and treatments that affect the immune system such as protein kinase inhibitors or PARP inhibitors), have also been identified at higher risk.

Thanks to the QCovid algorithm cancer patients now can be appropriately categorised and prioritised based on their type of cancer, current or previous cancer treatment and other factors such as corresponding health conditions that could make them more vulnerable to COVID-19.

The development of the QCovid model was led by the University of Oxford and involved researchers from Cambridge, Edinburgh, Swansea, Leicester, Nottingham, Liverpool, the London School of Hygiene & Tropical Medicine, Queen’s University Belfast, Queen Mary University of London and University College London. It was funded by the NIHR, NIHR Oxford Biomedical Research Centre, Wellcome Trust (ISSF) and John Fell Fund and supported by EMIS GP practices and the University of Nottingham.

The search for pancreatic cancer biomarkers

Pancreatic cancer has the lowest survival rate of any cancer in the UK, due in part to the limited ability to diagnose it at an early stage. Earlier detection of pancreatic cancer is a major priority of cancer researchers, in order to identify tumours at an earlier stage when they are more easily treatable.

Identifiable biomarkers (naturally occurring molecules which can be related to the presence of a cancer) is one method that can be used to predict or diagnose pancreatic cancer. Currently, the previously-identified biomarkers available have a limited ability to accurately diagnose pancreatic cancer. There is a need to identify new biomarkers that more accurately predict the presence of pancreatic cancer for improved earlier diagnosis.

Dr Christiana Kartsonaki, a senior scientist at the MRC Population Health Research Unit in the Nuffield Department of Population Health, is leading investigations on the potential of protein biomarkers in blood, using data from the China Kadoorie Biobank. Blood samples from over 500,000 Chinese adults have been collected as part of this data set, allowing researchers to identify circulating proteins in the blood and see which individuals went on to develop pancreatic cancer.

During 9 years of follow-up, 700 individuals from the ~500,000 went on to develop pancreatic cancer. From their blood samples, Dr Christiana Kartsonaki and her colleagues will be able to identify a number of protein biomarkers that are associated with a future risk of pancreatic cancer. This study builds on their previous work on the associations of metabolic and lifestyle factors with risk of pancreatic cancer.

Identification of biomarkers may prove very useful in the establishment of strategies to utilise these proteins in predicting the development of pancreatic cancer and help with its diagnosis.

Results from this research will likely be published next year. Once biomarkers are identified, this work may help researchers understand the role that individual proteins play in the development and progression of pancreatic cancer, and whether they may have therapeutic potential as drug targets in its treatment.

About the study

This study is funded by the Nuffield Department of Population Health, Pancreatic Cancer UK and the CRUK Oxford Centre. It was co-led by Associate Professor Michael Holmes, Professor Zhengming Chen, Dr Yuanjie Pang and Dr Christiana Kartsonaki.

Early stage ‘red flag’ symptoms for pancreatic cancer

Pancreatic cancer is the 11th most common cancer in the UK. However, the mortality rate remains the highest among all cancers, due to diagnosis at late stages. As a result, less than 20% of patients diagnosed with pancreatic cancer are suitable for surgery with curable intent, and only 16% of patients are likely to live longer than a year after diagnosis.

The survival rate is much higher when the cancer is found at an earlier stage. However, there is no national screening programme or reliable tests for pancreatic cancer. Most symptoms reported to be associated with pancreatic cancer are vague and non-specific, which increases the difficulty of general practitioners (GPs) recognising early signs of pancreatic cancer in the community.

Identifying red flag symptoms

To address this research gap, the ADEPTS study was set up, using linked data from GP records, hospital records, ONS mortality data, and cancer registry data from the QResearch database, with the aim to better understand the symptom profile of pancreatic ductal adenocarcinoma (PDAC) and pancreatic neuroendocrine neoplasms (PNEN, a rarer type of pancreatic cancer). The ADEPTS study is run by researchers from the Nuffield Department of Primary Care Health Sciences.

This is a case-control study. The team identified about 23600 patients diagnosed with PDAC and 600 patients with PNEN from the QResearch database in the last 20 years.

Up to 10 patients without cancer (controls) with the same age, sex, calendar year registered in the same general practice were identified and matched with each case (patient diagnosed with PDAC/PNEN). The team also identified a list of potential symptoms that may be associated with PDAC and/or PNEN through literature review, leading research charities like Cancer Research UK and Pancreatic Cancer UK, NICE guidelines, and patient representatives. The team explored the presentation of symptoms in different time windows (e.g. within 3 months, 6 months, 1 year, and 2 years before diagnosis) and the association with the diagnosis of PDAC and PNEN.

Through this analysis, a profile of symptoms that are associated with PNEN and PDAC can be determined, which can be used to update the QCancer (Pancreas) prediction model. The model can be used in primary care settings to help GP identify patients who are at high risk and investigate these patients in a timely manner.

So far, the team have already identified a number of red flag symptoms. The results will be published next year. They have also identified certain ethnic groups that are less likely to develop PDAC, along with certain co-morbidities (other health conditions beside pancreatic cancer) that could also be used to predict cancer risk.

Increasing public awareness and GP pathways

After publishing their study findings, the research team hope to engage with relevant stakeholders, to increase public awareness of symptoms that are associated with pancreatic cancer, such as weight loss, abdominal pain, jaundice, etc.

In conjunction with this, the ADEPTS study is working with GPs to improve better direct access to diagnostic investigation resources, such as ultrasound, CT scans and MRIs. This way, when a patient presents to their GP with symptoms, they can be quickly and accurately diagnosed in the hopes of identifying PDAC earlier.

Improved GP assessment tools are being developed as part of the study. By improving the identification and quantification of red flag symptoms associated with pancreatic cancer, the ADEPTS study will help GPs ensure that right patients are sent for the right investigatory methods, making efficient use of scarce or expensive resources such as MRI scans. By communicating its findings with GPs and patients, the ADEPTS study will increase public awareness of symptoms and prompt earlier diagnosis through investigation. Look out for the published findings next year.

About this study

 The ADEPTS study is funded by Pancreatic Cancer UK, and conducted by Weiqi Liao, Ashley Clift, Martina Patone, and Julia Hippisley-Cox from the Nuffield Department of Primary Care Health Sciences.

The QResearch database is founded and directed by Prof Julia Hippisley-Cox, who is the Principal Investigator of the ADEPTS project. External collaborators include Prof Carol Coupland (Medical Statistics) from the University of Nottingham, and Prof Stephen Pereira (Hepatology & Gastroenterology) from University College London.

Understanding breast cancer risk in Chinese populations

Obesity has long been associated with an increased risk of breast cancer in post-menopausal women. But the relationship between obesity and breast cancer is less clear in pre-menopausal women. Moreover, a lot of uncertainty remains around the associations between body weight and breast cancer in countries such as China, where the average BMI is lower than in western countries, along with differences in the prevalence of other risk factors between western and eastern cultures. There is a need to better understand how morphological and lifestyle differences between populations may influence cancer incidence, in order to better understand and identify who is at an increased risk.

An upcoming study from the Clinical Trial Service & Epidemiological Studies Unit (CTSU) at the Nuffield Department of Population Health, led by Dr Christiana Kartsonaki and Dr Ling Yang, is investigating breast cancer incidence in Chinese populations in relation to adiposity measures such as BMI, waist circumference and body fat percentage.

The team used data from the China Kadoorie Biobank, a cohort study that has collected information from over half a million individuals from China since 2004. During an average of 10 years of follow-up of this cohort, there were 2,053 cases of breast cancer, which allows the team to assess what demographic or lifestyle factors might be influencing risk in Chinese women.

Early results suggest that, like western populations, increased levels of adipose tissue leading to higher BMIs are associated with higher risks of breast cancer in Chinese women, particularly among post-menopausal women. These results highlight the importance of understanding relative cancer risk factors between different ethnicities. Whilst some factors such as obesity are often common causes of cancer across all populations, there are many key biological and lifestyle factors that differ between western and eastern populations. Understanding how these may impact cancer risk in different ways will allow researchers to inform policy, so that clinicians may better identify who may have a higher risk of developing cancer.

About the CTSU

The Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU) aims to generate and disseminate reliable evidence from observational epidemiology and from randomised trials that leads to practicable methods of avoiding premature death and disability.

This project is being led by Dr Christiana Kartsonaki and Dr Ling Yang in conjunction with Prof. Zhengming Chen.

Using big data in breast cancer research

Breast cancer is the most common type of cancer found in the UK population, with 1 in 8 women diagnosed during their lifetime. As a prevalent cancer, it’s important to understand more about the potential causes and relative risks that individuals from different demographics might have.

The Cancer Epidemiology Unit (CEU) at the Nuffield Department of Population Health specialises in large-scale studies into the lifestyle and genetic risk factors of cancers such as breast cancer. In doing so, these studies can provide evidence to inform public health policies and answer outstanding questions about how cancers may arise.

The cause of breast cancer has long been researched and over the last two decades, findings from the Unit’s large prospective studies and international collaborations have helped clarify the role of many risk factors for the disease, including use of menopausal hormones and oral contraceptives, as well as factors relating to childbearing. Within the last year, an updated review of the worldwide evidence carried out in CEU showed that menopausal hormone usage increases the long term risk of breast cancer by almost twice as much as was previously thought, findings which influenced public health guidance. Other recent work found evidence to suggest that high fruit and fibre intake and physical activity may be associated with lower risks of breast cancer.

The CEU work with big data, such as its Million Women Study which contains data from 1.3 million UK women, collected since it began  in 1996. The study includes 1 in 4 of all UK women born between 1935 and 1950 and remains the largest data set of its kind. The study, which aims to resurvey women every 3-5 years, continues to collect information on new potential risk factors such as working night-shifts (which in this case was shown to have no influence on breast cancer incidence).

Enhancing the quality and quantity of the Million Women Study dataset is high on the CEU’s agenda. One area of research where the study hopes to be able to contribute substantially over the next few years is in risk stratification for breast cancer. Prediction models which can be used to assess an individual’s breast cancer risk are key for planning risk-based screening approaches that are tailored to an individual, so refining their accuracy is important to ensure that interventions can be targeted appropriately. However, while existing risk prediction models look promising they need further improvement in their ability to identify those women who are most likely to get breast cancer before they can be applied at a population level. In particular, models should ideally incorporate the whole spectrum of breast cancer risk factors including genetic variation and radiological imaging data.

This will be the next stage for the Million Women Study, as Prof Gill Reeves, Head of the CEU, hopes to integrate new datasets into the study. This includes digital screening images from mammograms, and other clinical information, which could be used in combination with existing information held on participants, to allow the CEU to develop more accurate risk prediction models from the Million Women’s Study.

Prof Gill Reeves, Head of the CEU, says:

“Enriching the quality of datasets such as the Million Women Study will allow us to continue to provide reliable evidence regarding the effects of behavioural and biological factors on breast cancer risk, and help identify women who are at particularly high risk of the disease. In doing so, we can better inform public health advice, and clinical practice.”

To read more about the CEU’s work on breast cancer go to the  CEU website.

About the CEU

The CEU runs the Million Women’s Study (MWS) and EPIC-Oxford (two large cohort studies). Recent grant funding from CRUK has allowed for further enhancement of the MWS so that new clinical data and other potential risk factors for cancer may be integrated.

Prof Gill Reeves, Head of the CEU, is a Professor of Statistical Epidemiology. Her main research interests are the roles of hormonal and other risk factors in the development of female cancers.  She is particularly interested in risk factors and patterns of survival for molecular subtypes of breast cancer.