Inside you will find: Forgotten cancers: Bringing research funds and resources to bear on this area Our Staff: 5 minutes with Dr Lini Nair-Shalliker Our Insight: TA small change to the Death Registration Notice could save lives Research Discovery: How cancer cells learn to resist the drug treatments Join a Research Study - Make yourself available for research and help reduce the burden of cancer by completing a 5 minute questionnaire.

1. Research Report
Issue 24 • November 2013
FEATURED:
Forgotten cancers
2 Bringing research
funds and resources
to bear on this area
Our Staff
2 5 minutes with
Dr Lini NairShalliker
Our Insights
3 A small change to
Death Registration
could save lives
Research Discovery
4 How cancer cells
learn to resist drug
treatments
CLEAR Study:
We can now make our
data available to cancer
researchers
Cancer Council NSW invites other cancer
researchers to discuss projects for collaboration.
The NSW CLEAR study has collected data from over 9,000 people with
and without cancer to provide a better understanding of the genetic and
environmental causes of cancer in NSW.
The study was designed as an open resource for cancer researchers, and
the data and blood samples have now reached sufficient maturity to be made
available to the cancer research community.
Scientists can use the CLEAR data and blood samples to evaluate risk factors for cancer. Particular interest will be links
between cancer and smoking, infectious agents, hormones, sun exposure and sleep patterns, BMI/physical activity, and
alcohol.
As the CLEAR Study is an open resource, scientists may apply to use questionnaire data and blood samples for any
cancer research project, subject to scientific and ethical approval, without collaboration with Cancer Council NSW.
However, we also encourage researchers to discuss with us opportunities for collaborative projects, especially those
which bring expertise outside our areas of content knowledge.
CLEAR Study data by age
CLEAR Study data available by major cancer types
2,000
c er
C an e
t yp
1,500
Male
1,000
st
a
Non n’s
tate Hodgki ma
p ho
Lym
Participants
l
ntro
Co
<40
70
-79
9
40-4
9
50-5
9
60-6
ge
A
7
440
114
Female
1,504
338
129
233
–
93
Total
1,511
778
243
456
975
178
0
e
Lu ng
500
s
Ca
el
CLEAR Study data by birthplace
9
9 -9
9 0
80-8
B ir t h
p la c
Control
Brea
e
A u st
ra l ia
1,342
En g
la n d
140
C hin
a
M e la
nom
Pr o s
223
It al y
975
H oll
and
4
8
19
85
NZ
G re e
29
7
Case
4,246
460
50
66
54
113
34
Total
5,588
600
54
74
73
142
41
Visit clearstudy.org.au or email clearstudyenquiries@nswcc.org.au
Cancer Council 13 11 20
cancercouncil.com.au
B ow
ce

2. Forgotten cancers cause
more than a third of all
cancer deaths
They account for 35% of all NSW cancer deaths yet
are under-funded and under-researched.
“Many cancer types are grossly under-funded and under-resourced, yet
they are among the most common causes of cancer deaths in Australia.
We call these the forgotten cancers,” said A/Professor Freddy Sitas of
Cancer Council NSW.
Figures recently released by Cancer Council NSW show pancreatic
and thyroid cancer have seen the least improvements in cancer death
reduction over a 20 year study period — only a 6% reduction in death rate,
while liver cancer has seen an increase.
Under-funded cancers such as pancreatic cancer, cancer of the unknown
primary, and liver cancer are in the top ten most common causes of cancer
death in Australia, while brain cancer remains the leading cause of cancer
death in children and young people.
A reminder that forgotten cancers are killing people
yet receive little attention, funding or support for
their sufferers
On average, 40 Australians die from these forgotten cancers every day.
Because of this, Cancer Council NSW has made many of these cancers a
key focus for new research. Brain and pancreatic cancer are our second
and third most funded cancers, each receiving close to $1m in research
funding this year.
For more information, visit cancercouncil.com.au
Five minutes with
Dr Lini Nair-Shalliker
What is your position within Cancer Research Division?
I started as a PhD student through the University of Sydney.
After that I was employed as a Research Fellow for the
CLEAR Study in 2011. I manage the operations and strategic
direction of the CLEAR Study under the guidance of the study’s
investigators.
How will the CLEAR Study benefit Cancer Council NSW?
By reinforcing the organisation as a reputable and innovative
research institution in the forefront of cancer research.
From your perspective, why is the CLEAR Study important?
Dr Visalini Nair-Shalliker
The aim of CLEAR is to study gene-environment interactions and
to try to discover whether a disease like cancer can be prevented
We are close to reaching the initial 10,000
by reducing our exposure to environmental risks. It is one of the few studies
recruitment target for the CLEAR Study. Only
that has such a concise collection of a variety of environmental, social and
450 to go! Our next target will be 25,000.
lifestyle factors as well as blood and tissue samples.
And we are beginning to promote the
What are the aims for the CLEAR Study now?
availability of the data (bloods and
We are focussing on recruiting from our culturally and linguistically diverse
questionnaires) to other researchers with the
community. We have translated our study materials into 5 languages and are
goal of attracting collaborators.
looking for help to distribute this new information.
For more information, visit: cancercouncil.com.au
Cancer Council 13 11 20
cancercouncil.com.au

3. Here’s a simple question
that could save lives:
“Was the deceased a smoker five years ago?”
A new report highlights how this simple yes/no question about smoking on
South African death registration forms has led to new understandings about
deaths caused by smoking, and provided a valuable profile of the effect of
smoking on different population groups in that country.
This new insight has stimulated leading Australian researchers to call for a
similar question on smoking to be included on death registration forms in
Australia and around the world.
“…a simple yes/no
question on death
registration forms
has led to new
insights about
deaths caused by
smoking.”
Lead author and cancer epidemiologist,
A/Professor Freddy Sitas, Cancer Council
NSW, plans to present these key findings
to the World Health Organization. “This
model should become international
best practice for any country that has
reasonable death certification.”
Eminent international cancer
epidemiologist, Professor Sir Richard
Peto from Oxford University, and another
lead author on the study, adds: “This is a
cheap and easy intervention that ought to be implemented worldwide.”
South Africa is the only country to record smoking status on the death
certificate. “Working with colleagues in South Africa and the UK we
analysed half a million deaths from South Africa, making this one of the
largest studies on death from tobacco in the world,” said A/Professor Sitas.
”What surprised us were the striking differences in the profile of deaths from
smoking in each population group — in the black population we found that
the main way it killed was by increasing the mortality rate from tuberculosis,
cancer and other lung diseases. In the white population we saw an increase
in risk from cancer and heart disease, but surprisingly an increase in
respiratory diseases. The mixed race population smoked more than any
other group and had about double the death rate from smoking than that of
white South Africans. This is of real relevance to countries with large multicultural populations, like Australia.”
Leading cause of death in smokers in South Africa
Population group
Smokers
Black
White
Mixed
Leading cause of
death: 1
2
3
Male
Female
Male
Female
Male
Female
50%
12%
47%
28%
68%
46%
Tuberculosis
Other respiratory
disease
Upper aerodigestive
cancer
Ischaemic heart
disease
Chronic obstructive
pulmonary disease
Lung cancer
Tuberculosis
Chronic obstructive
pulmonary disease
Other respiratory
disease
Question on South African Register of Death form
Although smoking levels in Australia are
declining, tobacco is still one of the leading
causes of preventable deaths affecting 1519,000 people per annum.
To arrive at these figures, Australia
extrapolates estimates from other western
countries, “but in a multicultural country
like Australia we ought to be getting more
accurate data and trends over a long period
of time,” said A/Professor Sitas.
“If we replicate this work in Australia
the results could be more startling than
expected. There could be a huge variation
in smoking related deaths among our
indigenous, migrant, rural populations,
or those who are marginalised. Accurate
information will help us focus our prevention
programs. We could also find out more
details about the range of diseases directly
linked to smoking. There are about 60,000
doctors in Australia and about 150,000
deaths per annum. We are really not talking
about a lot of extra work.”
The study was funded by the South African
Medical Research Council, the UK Medical
Research Council, Cancer Council NSW,
Cancer Research UK and the British Heart
Foundation.
For full article and comment, visit:
http://press.thelancet.com/southafricasmoking.pdf
Cancer Council NSW Research Report
Issue 24 • November 2013

4. Cancer cells teach
each other how to
resist treatment
It can take just four hours for a
cancer cell to learn how to resist
cancer drug treatments.
Over time cancer cells can become resistant to
drugs. Now A/Professor Mary Bebawy has made
a remarkable discovery as to how it happens: she
found that resistant cells actually share with other
surrounding cells the ‘knowledge’ necessary to
protect them from cancer treatments.
A/Professor Mary Bebawy, together with Professor
Georges Grau, found a previously unknown
mechanism for cancer cells to teach each other
how to resist treatment. A resistant cancer cell
can shed tiny vesicles, or micro particles, from its
surface. These vesicles are actually tiny packages
full of genetic information that act as messengers
Drug resistant cells can share their ‘knowledge’ with surrounding cells
between the cancer cells. The micro particles dock onto a drug-sensitive
cancer cell and within two hours they release their contents into the cell. As
early as four hours later that cell is multi-drug resistant cancer cell.
If A/Professor Bebawy and her team can understand how these cells resist
treatments, this could lead to the development of new drugs able
to circumvent them or tests to detect when cells are becoming resistant
to therapy.
For more information, visit: cancercouncil.com.au
A/Professor Freddy Sitas awarded
AG Oettlé Memorial Medal
This medal is awarded to South Africans who
through original research have made valuable
contributions in regard to cancer
A/Professor Freddy Sitas, Director of the Cancer Research Division,
has received the prestigious AG Oettlé Award for his pioneering
epidemiological work at the National Cancer Registry in South Africa.
Register to
join a research
study today!
Return completed form to:
Reply Paid 79819
Potts Point, NSW 1335
Cancer Council and other academic bodies conduct
research studies to do with cancer. These studies may
be questionnaire based surveys, focus groups and
interviews or other types of research. Study participants
will not necessarily be cancer patients.
Title*
Register your interest to be included on our database.
Your story or the story of someone you know will help us
find the answers.
Address*
Yes, include me on the database. (If yes, we will
write to ask you some additional questions relating
to your health to allow us to match you to research
studies that suit you.)
Tick this box if you have been diagnosed with
cancer in the past 18 months. (If yes, you may be
eligible for the CLEAR Study and we will send you
further information.)
You can also register at cancercouncil.com.au/joinastudy
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* Mandatory
At Cancer Council we recognise the importance of your privacy and the safeguarding of your personal information. If you have concerns about the privacy of this information, you may provide it securely online at cancercouncil.com.au/joinastudy. Please be
assured that in collecting this information, it will be used for research purposes only, and will be handled in accordance with our Privacy Management Plan (www.cancercouncil.com.au) which addresses our compliance with all legislative requirements.
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