Catherine, Princess of Wales, revealed that she is receiving treatment for cancer found after planned abdominal surgery in January. Initially, the 42-year-old’s condition was believed to be non-malignant, but post-operative tests found she had the disease. She did not reveal the form of the cancer, or its stage. She said she was “well”, had reassured her children she would be “OK” and would now be undergoing “preventive chemotherapy”.
What exactly is ‘preventive chemotherapy’?
This is not an expression that clinicians generally use, preferring the term “adjuvant” therapy. Essentially, it is a way to target any remaining cancer cells after an operation to excise a solid tumour.
Occasionally, some cancer cells “escape the organ of their origin and start residing in other organs such as lung or liver”, said Dr Mangesh Thorat, honorary reader at Queen Mary University of London and a consultant breast surgeon.
Tests and scans presently available were not able to detect such a microscopic spread, he added. “Therefore, to improve chances of cure, presumptive treatment of such likely spread is often undertaken even after the cancer in the solid organ of origin is completely removed.”
On average, a course of chemotherapy lasts between three and six months. Scientists say cancer survival rates are generally better for younger people. They are often healthier than older patients and so more resilient to the side-effects of the treatment.
“Young people . . . better tolerate higher doses of chemotherapy and so can be given stronger regimens that are more likely to kill any leftover cells,” said Andrew Beggs, consultant colorectal surgeon at Queen Elizabeth Hospital in Birmingham and a professor at Birmingham university.
How unusual is it for someone of the Princess of Wales’s age to be diagnosed with cancer?
It is uncommon, but not as rare as it used to be. Cancer Research UK says that out of about 400,000 people diagnosed in the country each year, fewer than 10 per cent are under 50 years old, and more than 50 per cent are between 50 and 74 years old. The absolute risk of contracting cancer peaks between the ages of 85 and 89, the charity said.
However, over the past few decades there has been a marked rise in people being diagnosed with cancer before reaching their 50th birthday. Experts still have no definitive explanation for this, but they suspect it may be linked to dietary and other changes in lifestyle and the environment that began to take root around the middle of the last century.
The majority of national cancer screening programmes apply in later middle age, so the rise in detection is thought unlikely to be the result of increased medical monitoring.
Global incidence of early-onset cancer rose 79 per cent and the number of early-onset cancer deaths almost 28 per cent between 1990 and 2019, according to a study published in the British Medical Journal last year.
Female breast cancer is the most common form of cancer in the UK and accounts for 15 per cent of all new cases, according to the Breast Cancer UK charity. About 18 per cent of those are in women under 50.
Cases of breast cancer in 15 to 39-year-olds in G20 nations rose 42 per cent between 1990 and 2019, according to FT research. “There is an epidemic currently of young people getting cancer,” said Dr Shivan Sivakumar, associate professor in oncology at Birmingham university. This includes “more patients getting abdominal cancers”, he noted.
Other experts warn that some of the trends need to be kept in perspective. While the biggest increases in colorectal cancer were occurring in the under-50s “these are big percentage increases on small numbers”, said Naser Turabi, director of evidence and implementation at Cancer Research UK.
How common is it for cancer to be diagnosed post-surgery for another condition?
Data is scant on numbers of people diagnosed in the hospital after surgery, said Cancer Research’s Turabi. An incidental finding of cancer as a result of treatment for other conditions “is often associated with the tumour being detected at an early stage”, said Lawrence Young, professor of molecular oncology at Warwick university. This might mean subsequent chemotherapy is “much more effective”, he added.
The cancer of King Charles, announced in February, was also diagnosed incidentally. The monarch had undergone surgery for an enlarged prostate. Buckingham Palace has not given details about the nature of his condition, though it has said it is not prostate cancer.
How long are waiting lists for cancer treatment?
The Princess of Wales had her abdominal surgery in the private London Clinic, where she praised her medical team. But many patients reliant on England’s taxpayer-funded NHS are facing a long wait for diagnosis and treatment.
None of the health service’s waiting time targets for cancer care has been met since 2015, as demand for treatment has soared. That reflects both an ageing population and earlier diagnoses.
The deterioration in performance has levelled out over the past 18 months but waiting times have not significantly improved. For example, one target requires that at least 85 per cent of people should begin treatment within 62 days of an urgent referral for suspected cancer. The most recent data, for January, found only 62 per cent were doing so.
The longest delays were sometimes between someone first experiencing symptoms and seeing a doctor, Turabi said. That meant it was helpful when someone of a high profile such as the princess raised awareness of the need for people to check for potential problems.
“It’s actually very positive when public figures open up about cancer diagnoses because it’s an opportunity to encourage people to think about their own health,” he said.
Is cancer diagnosis becoming more sophisticated because of new technologies, such as AI?
The technologies for detecting and treating cancer have undergone a revolution over the past 20 to 30 years. Molecular diagnostics have made it possible to analyse the distinct genetic make-up of a tumour, offering the prospect of treatments better tailored to the individual.
Experts say it is increasingly important to differentiate between cancers that ultimately cause serious harm as opposed to those that can be managed.
For example, there has been a big increase in the recorded incidence of male prostate cancer but very little associated increase in mortality, Turabi said. “That suggests that there’s significant over-diagnosis,” he added.
The more sophisticated the diagnostics, the higher the chances of detecting such cancers, he said. The development of artificial intelligence to detect tumours and direct treatment was one example.
“And so it becomes really important that we collect longitudinal evidence to actually measure whether we’re finding cancers that cause people harm or not,” he said.