Cancer
Walking may lower cardiovascular death risk for women with cancer history
Among postmenopausal women with a history of cancer, taking more daily steps and engaging in moderate-to-vigorous physical activity were both associated with a significantly reduced risk of death from cardiovascular disease, according to a new study.
Cancer survivors are at an increased risk of death from cardiovascular disease, according to a 2019 scientific statement from the Association. The statement also noted that exercise training is an essential part of cardiac rehabilitation and recovery after cancer treatment, and that exercise therapy can help to reduce cardiovascular toxicity during cancer treatment.
“Encouraging cancer survivors to be more active, sit less and take more steps every day could be a feasible approach for prolonging survivorship and reducing the risk of cardiovascular disease mortality,” said lead study author Eric Hyde, a research analyst at the University of California, San Diego.
“Our study helps us to better understand potential physical activity behaviours of postmenopausal women in relation to cancer survival.”
Researchers examined physical activity data from the Women’s Health Accelerometry Collaboration, a study combining two observational studies exploring the relationship among physical activity and sedentary behaviour with cancer incidence and death.
They assessed the potential associations of physical activity and sedentary behaviour with death from cardiovascular disease or all-cause mortality (death from any cause).
The study followed for about eight years nearly 2,500 post-menopausal women between the ages of 63 and 99 years. The analysis included participants diagnosed with breast or other cancers at least one year before enrolling in the studies.
Participants wore an accelerometer on the hip for at least 10 hours per day for up to one week. The device recorded daily physical activity, including light physical activity, moderate-to-vigorous physical activity, total physical activity and step counts. It also recorded sedentary behavior including total sitting time during awake hours.
After adjusting for age, race/ethnicity, various lifestyle and risk factors for cardiovascular disease, cancer type and years since cancer diagnosis, the study found that more daily steps and more moderate-to-vigorous physical activity were associated with a progressively lower risk of all-cause mortality; that the greatest benefit was seen among participants who logged 5,000–6,000 steps per day, and their risk of all-cause mortality was reduced by 40 per cent; and, each additional 2,500 steps per day was also incrementally associated with a 34 per cent reduction in risk of death from cardiovascular disease.
It also found that the greatest benefit from moderate-to-vigorous physical activity was seen among participants with at least one hour per day, which reduced all-cause mortality risk by 40% and cardiovascular disease mortality risk by 60 per cent. However, significant reductions in risk were also evident at amounts far below one hour per day, researchers noted.
Furthermore, every 102-minutes of sitting time per day was associated with a 12 per cent increased risk of all-cause mortality and a 30 per cent higher risk of death from cardiovascular disease.
“Risk reductions were even evident when participants walked fewer than 5,000 steps per day, half of the often touted 10,000 steps per day threshold,” Hyde said.
“Daily steps are an important measure because they are easily understood by the public, can be at any intensity level and are recorded on wearable devices like smartwatches that are increasingly being worn by all.”
Keith Diaz, the Florence Irving Associate Professor of Behavioral Medicine at Columbia University Medical Center in New York, noted that the study’s findings add to the understanding of how to manage health and promote longevity after a cancer diagnosis.
“While structured exercise remains the most efficient and effective way to improve your health, these findings highlight that walking – at any intensity – matters. The road to an active lifestyle is more accessible than we often assume, and the benefits are available to everyone, including people navigating life after cancer,” said Diaz, who was not involved in the study.
“Another key takeaway from this study is the impact of sedentary time. Many adults now spend the majority of their day sitting, not engaged in physical activity, and for cancer survivors, this issue is likely even more pronounced due to the physical toll of cancer treatment and recovery. These findings add to the growing body of evidence that prolonged sitting is a significant health risk—one that we must actively combat, particularly after a cancer diagnosis.”
A vaccine trial will test whether an mRNA jab can help stop precancerous cells developing into bowel and ovarian cancer in people with Lynch syndrome.
The first stage is due to launch this summer and will assess whether the jab can train the immune system to recognise and eliminate precancerous cells before cancer develops.
Around 175,000 people in England have Lynch syndrome, but only five per cent, or around 10,000 people, know they have it.
The inherited condition increases the risk of developing bowel cancer by 80 per cent and is linked to around 1,100 bowel cancer cases each year.
Lynch syndrome is also linked to a far higher risk of bowel, womb and ovarian cancer, alongside other types including stomach, pancreatic, kidney and skin cancer.
While the syndrome does not directly cause cancer, the genetic changes can lead to more abnormal cells developing, which then multiply and increase the risk of cancers such as bowel, prostate and endometrial cancer.
It is caused by an alteration in a mismatch repair gene. Carriers do not have any symptoms.
The new Intercept-Lynch trial is part of a scientific collaboration between the University of Oxford and Moderna, while Cancer Research UK has backed the vaccine’s development.
Once patients receive the new mRNA-4194 jab, experts will analyse their immune responses, assess the best dose and check whether the jab is safe.
The second phase of the study will include multiple centres across the UK, including Oxford, and is expected to begin in 2027.
The aim of the trial is to train the immune system with a vaccine to recognise abnormalities and stop them developing into cancer.
Professor David Church, Cancer Research UK senior cancer research fellow in the University of Oxford’s centre for human genetics and lead investigator of the trial, said: “People with Lynch syndrome are at risk of cancers over their entire lives.
“So, it’s very common, for instance, a woman to have a first cancer of her womb, and then some years later have a bowel cancer, or vice versa.
“The targets we’ve chosen for the vaccine were chosen based on their sharedness across multiple cancer types in Lynch syndrome, so we think they should provide broad protection, if the vaccine works.”
In people with Lynch syndrome, mutations can build up, making the cells containing them more likely to turn into cancerous cells.
However, those mutations can be made visible to the immune system and, with enough stimulation, the immune system can attack the abnormal cells and stop cancer from forming.
Professor Church said the mRNA jab acts as “an instruction manual” for the body to attack precancerous cells.
He added that, as with many vaccines, patients may need a booster jab at some stage.
On whether similar approaches could help prevent cancers not caused by Lynch syndrome, Professor Church said: “In terms of proof of principle that we can train the immune system to recognise these cancer-associated alterations and enhance the immune response against them to prevent these pre-cancers or prevent the progression of pre-cancer to cancer, that proof of principle should give us insights that are generalisable.”
David Berman, chief development officer at Moderna, said: “By applying mRNA technology earlier in the patient journey, we aim to harness the immune system when it can have the greatest impact.
“We are proud to bring this innovation to the UK, building on our long-standing collaboration with leading UK institutions to advance mRNA research and development.”
Changes in lymph nodes may help show which breast cancer patients face higher or lower risk of the disease spreading, researchers have found.
The findings could support more tailored care, new treatments and help more people avoid unnecessary treatment.
Dr Simon Vincent is chief scientific officer at Breast Cancer Now, which funded the research:
He said: “These findings suggest that changes to the structure of the lymph nodes are more than just a consequence of the cancer. They can also play an active role in helping breast cancer progress.
“With one person tragically dying from breast cancer every 45 minutes in the UK, we urgently need research like this so that we can better understand who is most at risk of their cancer progressing and becoming incurable. Only then we can find ways to stop it.
“With a better understanding of how lymph nodes change as breast cancer spreads, we could find new targets for future treatments for types of breast cancer that are harder to treat.”
Lymph nodes, a key part of the immune system, help the body fight infections and cancer. In breast cancer, the lymph nodes in the armpit are often the first place the disease spreads to.
At the moment, everyone with invasive breast cancer has to undergo surgery to remove lymph nodes so doctors can check for cancer cells.
Invasive breast cancer means cancer that has spread beyond where it first developed in the breast into nearby tissue.
While this is effective, it can lead to long-term side effects such as swelling of the arm, known as lymphoedema, and may be unnecessary for some patients, particularly those with early-stage disease or those whose cancer responds well to treatment.
The study analysed 331 lymph node samples from people with different types of breast cancer and compared them with healthy lymph nodes from people free from the disease.
It found that breast cancer could change the structure of a network that supports the lymph nodes.
Crucially, some of these changes could occur before doctors were able to spot any cancer cells in the network.
Some changes were linked to a better chance of survival, while others were associated with a poorer prognosis.
Dr Amy Llewellyn and Dr Kalnisha Naidoo from King’s College London, together with professor Sophie Acton at University College London, compared the 331 samples with healthy lymph nodes in people free from the disease.
They looked at fibroblastic reticular cells, known as FRCs, a group of cells in lymph nodes that provide their structure, control fluid flow and activate different immune cells.
The study showed that the structure of this FRC network could change before the cancer had spread and differed depending on the type of breast cancer, any spread and whether someone had received chemotherapy.
Chemotherapy uses medicines to kill cancer cells or slow their growth.
The researchers said the findings could help doctors better understand who is most at risk of breast cancer spreading.
Dr Llewellyn said the first large-scale analysis of FRC in human lymph node tissue from breast cancer patients was addressing the “urgent need” for a better understanding of the area’s biology.
A new ovarian cancer drug has been approved for NHS use in England, offering hundreds of women with hard-to-treat disease a life-prolonging treatment.
Elahere is the first new drug for chemotherapy-resistant ovarian cancer to be approved by the NHS for more than 20 years.
Ovarian cancer is the 18th most common type of cancer globally, affecting more than 300,000 women a year.
More than three-quarters of patients are diagnosed at an advanced stage, making the disease harder to treat.
Prof Ruth Plummer, national clinical lead for cancer drugs at NHS England, said: “This represents the most significant breakthrough in NHS treatment for these hard-to-treat ovarian cancers in over two decades – and we’re delighted it will now offer hundreds of women much-needed hope of precious extra time with their loved ones.”
Standard treatment for ovarian cancer usually involves surgery and chemotherapy, but about 80 per cent of patients with advanced disease relapse and most eventually develop resistance to chemotherapy.
According to the National Institute for Health and Care Excellence, patients with folate receptor-alpha-positive platinum-resistant epithelial cancers have until now had limited options when their tumours stop responding to standard chemotherapy.
Now NICE has approved mirvetuximab soravtansine, also known as Elahere, for patients with epithelial ovarian, peritoneal or fallopian tube cancer that has become resistant to platinum-based chemotherapy and whose tumours contain the FRα protein that the drug targets.
FRα is a protein found on the surface of some cancer cells.
NHS England said up to 400 women a year in England could benefit, in what it described as a major milestone for treatment.
Mirvetuximab soravtansine is given through a drip once every three weeks.
A global clinical trial involving eight NHS hospitals found that the treatment delayed cancer progression and prolonged survival by an average of four months, compared with chemotherapy alone, with more manageable side-effects.
Cancer progression means the disease is growing, spreading or worsening.
In 37 per cent of patients, tumours shrank by at least 30 per cent, compared with 16 per cent of those given chemotherapy.
The drug, made by AbbVie, combines a “homing” antibody, which seeks out the FRα protein on the surface of cancer cells, with a cancer-killing molecule that destroys the cell from within.
Experts said the decision was a seminal moment and could significantly improve the quality of life of affected patients.
Rachel Downing, head of policy and external affairs at Target Ovarian Cancer, said: “This is a hugely important moment for women with platinum-resistant ovarian cancer and their families, who have faced limited effective treatment options for far too long. Today’s announcement offers real hope of improved quality of life.”
Victoria Clare, chief executive of the charity Ovacome, said: “Today marks a landmark moment. Being told that platinum-based chemotherapy is no longer working can bring anxiety and uncertainty, particularly when the disease is at an advanced stage, where time and options are limited.
“This recommendation is the first in over 20 years to offer the ovarian cancer community an additional choice at a critical stage, with the potential to make a real difference to patients and their families.”
Helen Knight, director of medicines evaluation at NICE, said: “We heard clearly from patients and clinicians about the very limited options available at this stage of the disease and the substantial burden that chemotherapy places on women’s lives.
“We are pleased that, following a robust process and a new commercial arrangement with AbbVie, we are now able to recommend this treatment for NHS use.”
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