A city choked by its history

July 16, 2004

Liverpool's lung cancer rate is twice the national average. A new research centre will tackle the problem locally. Ross Davies reports.

This summer, George Xinarianos, a research fellow on the Liverpool Lung Project, is in Dallas, Texas, helping to set up an Anglo-American research programme on lung cancer. The collaboration, between Liverpool and Texas universities, is the latest in a multimillion-pound cancer research programme based in Merseyside.

For Xinarianos, a molecular biologist and geneticist, his work to identify genetic changes in lung cancer cultures exposed to carcinogens is both emotionally and academically rewarding. He comes from Greece, a country whose population has a tradition of heavy smoking and where lung cancer rates have yet to fall. His interest in the disease also stems from family reasons.

But the city in which he now lives and works is emotionally involved, too.

Lung cancer incidence in Liverpool is twice the national average, an average that is itself one of Europe's highest.

John Caldwell, dean of Liverpool University's School of Medicine, describes what this means in human terms: "There are still people coming into Accident and Emergency at the Royal (Royal Liverpool University Hospital) and saying, 'I've got a terrible cough, I can't shift it.' They've got advanced lung cancer, and it's the first time they, or anybody who could have helped them, has heard about it." They can be in their 40s or early 50s - "far too young," he says.

Pollution, poor diet, heavy smoking - cancer feeds on the toxic leavings of Merseyside's industrial past. Long a tobacco manufacturing centre, Liverpool still has an Imperial Tobacco factory. Often the people arriving at A&E are those who "don't expect to feel very well", Caldwell says, "people who are used to waking up coughing until they've had their first cigarette, people who don't pester for health spend - they're not the educated, vociferous middle classes."

Caldwell, who came to Liverpool two years ago from Imperial College London, argues that it makes sense if more research and treatment centres are in regions where there is a lot of cancer. "The patients are in one place and the resources are very often in another," he says. His answer is not to lower the standards by which grant applications are measured, but to tilt the scales with more heavyweight funding applications.

Enter, in Liverpool University's centenary year, its new Cancer Research Centre, a purpose-built modern glass building opposite the Royal. The university paid £3 million for the building to the Roy Castle Lung Cancer Foundation, which will continue to use it as headquarters and home to the Roy Castle Lung Cancer Research Programme. This is part of an investment programme by the university, local charities and the National Health Service that, combined with grant income and research expenditure, could amount to £20 million.

The European Commission has awarded the university and foundation nearly Pounds 2 million over three years to coordinate a Europe-wide research project involving 12 teams from seven countries to try to identify genetic markers that could help detect lung cancer early. The project, the European Union Early Lung Cancer Collaboration, will involve recruiting 1,200 patients to provide specimens for genetic and pathological analysis at the research centre's new EU bronchial tissue bank.

Its leader, John Field, says that although lung cancer deaths - 34,000 in the UK in 2002 - appear to have peaked, about 25 per cent of the population still smokes, so the disease will continue to be a big killer for years to come. "Women started smoking much later than men and fewer have stopped, so their lung cancer rates are still increasing or falling less rapidly," he says.

Lung cancer is the UK's biggest cancer killer, accounting for about 25 per cent of all cancer deaths, yet the disease attracts a mere 3 per cent of cancer research spending. By contrast, leukaemia, with a mortality rate about one-seventh that of lung cancer, attracts about six times as much research spend.

But Field's way of tackling lung cancer is not purely financial. "We should ban smoking in public places," he argues. He also urges a move to a national screening programme to detect lung cancer earlier among high-risk individuals. Finally, helped by work being carried out by the Liverpool Lung Project, he wants individuals identified as likely to develop lung cancer to be screened before the disease takes hold.

The university's Cancer Research Centre team is about 100 strong, but this is projected to rise to at least 150 over the next three years. "Active discussions" are under way to fill two new oncology chairs - one clinical, one non-clinical, each with substantial lecturing, clerical, technical and research support. The aim is to develop an "attractive package" that can attract and deliver on research grants.

Caldwell says Liverpool is already doing "absolutely top- rank" well-resourced research into cancers other than of the lung, including research into secondary tumours in women with primary breast cancer.

"I want to expand the research portfolio," he says. "My overall strategy for Liverpool is to identify problems of local and regional significance, which represent opportunities for us, and for us be seen to tackle problems of direct relevance to local people and local health services with work of international quality."

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