Cancer Institute NSW

Jim Bishop, CEO of the Cancer Institute NSW, spoke about the state of play at the Institute 18 months after its launch, the progress it has made so far and its plans for the coming year at in Sydney last week.

Based at the Australian Technology Park in Sydney, the institute was set up by the federal government in June 2003, by a unanimous vote in parliament, and has the task of improving cancer control in NSW.

"The institute is Australia's first state-wide government support for cancer control agency," said Bishop. "There are similar institutes overseas, and we are receiving support from the experience of these institutes in Canada, the US, the UK and Europe."

Bishop said it has been a difficult period setting up the institute -- the institute has gone from being one person, himself, to 90 staff and has established six program areas: cancer prevention, cancer screening, clinical enhancement, cancer research, cancer information services, and communicating health messages.

"It has been a rapid start up to running," said Bishop. "We have had to deal with setting up programs, building the building blocks, with AUD$100 million in 18 months."

One focus of the institute in the last year has been the tobacco program, which received $3.25 million in funding in 2004/2005 and will receive a further $5.9 million in 2005/2006.

"We brought the major players from around the country together and set up an advertising campaign based on the excuses people have for not quitting smoking," said Bishop, adding that tobacco is responsible for 20 per cent of cancer deaths.

Bishop said the number of calls to the smoking quit line were the highest ever after the advertising campaign.

The institute has also been successful in getting the government to ban smoking in pubs and clubs -- an initiative that failed in 1996/97.

"The government is taking a balanced approach to this and will phase in the ban," said Bishop. "The whole eastern seaboard - Victoria, Queensland and New South Wales - are lined up to go down this same route at the same time."

Initially pubs and clubs will confine smoking to a particular area or room, and subsequently smoking inside a venue will be banned altogether, as has occurred in Ireland.

Cancer screening

Another aim the Institute has is to increase the number of people that participate in cancer screening programs -- for example, 50 per cent of women in NSW participate in screening for breast cancer at the moment, and Bishop wants to see that figure reach 100 per cent.

He also wants the entire population to be screened for bowel cancer - estimating that this would save 300 lives per year in NSW.

"Screening is a hot topic," said Bishop. "Our great hope is to detect cancer early and this is not only to increase survival but also to decrease incidence, because if you get rid of premalignant polyps you decrease the chance of [bowel] cancer occurring in the first place."

Bishop said the development of a kit to effectively screen for bowel cancer would not be a problem as there are enough commercial entities around to provide for this, but he identified other potential problems, such as how to introduce and set up such a screening program, as well as who would implement the screening.

"We need to look at the workforce," he said. "The UK has three colonoscopy training centres set up and we are looking at that."

The federal government has invested $43 million in bowel cancer screening over four years, but Bishop said that it would cost $70 million per year to introduce such a screening process into NSW.

A bowel cancer screening program would involve GPs, like cervical cancer screening, and therefore setting up such a program would involve interaction with GPs as well as setting up an information system to support it.

"In July 2006 the government plans to introduce bowel cancer screening in two age groups - 55 and 65 years old," said Bishop. "It's a good start, but it leaves out a lot of the population."

Prostate cancer is another area the institute is interested in progressing.

The current screening test for prostate cancer involves screening for prostate-specific antigen (PSA), a protein produced by the cells of the prostate gland, in the blood. However, this test is unreliable and Bishop said they hope that a better test will be available in the future.

"We have provided $3.7 million to develop a group linking the Garvan, CSIRO, St Vincent's, the Prince of Wales, Westmead and Prince Alfred hospitals to develop a genomic approach to this, led by Dr Susan Clark at the Garvan," said Bishop.

Research initiatives

So far the institute has spent more than $7 million on new cancer research initiatives and plans to spend more than $16 million this year.

"Cancer research in NSW is very dispersed," said Bishop. "There are approximately 400 researchers with about 200 support staff spread across various institutes and of 80 separate groups only 14 have 10 or more people.

"The funding model currently tends to support individuals, not collaborations and one of our aims is to change this to support more collaborations."

The institute has set up project grants, called 'bench to bedside' grants, and 20 clinical trials units are getting support under this program.

Bishop said that by investing $7 million in clinical trial infrastructure, the institute is helping to build scientific capacity behind this, which could then be translated into liaisons with industry.

"NSW is the best state for cancer research and commercialisation of this," Bishop said. "But research can be locked up within commercial entities -- our role is to make an interface with research in academia and industry. We plan to set up a round table with research institutes and industry as a start to this interaction."

Cancer information and cancer registries are also a big focus for the institute, and Bishop cited a clinical cancer registry roll out they are undertaking in 30 hospitals.

The incidence of cancer is rising in Australia, in NSW it rose from 32,000 in 2003 and is predicted to reach more than 40,000 by 2011.

"By far the most common cancer will be prostate," predicted Bishop.

However, according to Bishop, the death rate for some cancers is decreasing dramatically -- a decrease of 20 per cent has occurred for prostate, bowel and breast cancer in the last five years.

Cancers on the increase include lung cancer in women, melanoma and liver cancer, especially in the Asian population in Australia.

This is where community education comes in, which is another focus of the Cancer Institute NSW.

As well as developing its website, the institute is constructing a cancer services directory, provides orientation for new cancer health professionals, is establishing basic courses in oncology, and coordinating 'town hall' meetings and community forums to find out what the issues are from the health professional and community perspective. "One of the reasons why melanoma is on the increase is because of a lack of awareness," said Bishop. "It has increased by 10 per cent in men and 12 per cent in women over the last decade. One of our plans for this year is to initiate an awareness campaign for melanoma."