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Letters to the Editor Issue 281

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listed in letters to the editor, originally published in issue 281 - September 2022

Consultant Surgeon Highlights Awareness Around Metastatic Breast Cancer Following Olivia Newton John’s Fight With The Disease

The death of Olivia Newton-John at the age of 73 has drawn attention to a little-understood stage of breast cancer – metastatic breast cancer.

The Australian actress was first diagnosed with breast cancer in 1992, after which she underwent a partial mastectomy, followed by chemotherapy and breast reconstruction. Newton-John spent 25 years in remission but announced that the cancer had returned in 2017, this time in her spine.

While it’s rare for cancer to return after more than two decades in remission, consultants at London’s New Victoria Hospital say that Newton-John’s passing highlights why it is important for women and men who have a history of breast cancer before to keep up with routine screenings.

Breast lumps are very common and while the majority, at least 90%, turn out to be benign, meaning no cancerous growths, it’s critical that women are vigilant and breast aware. Patients should be able to discern how their breasts should look and feel at different times in their menstrual cycle or during the menopause journey detecting any changes.

Miss Sarah Tang is a breast surgeon at New Victoria Hospital who has expertise in treating a broad range of breast conditions and offers one-stop breast clinics, surgery for breast cancer, surgery for benign breast conditions and cosmetic breast surgery. In light of Olivia Newton John’s passing, she explained how metastatic breast cancer develops and the modern treatments available for patients at New Victoria Hospital.

What is Breast Cancer and How is it Detected?

Breast cancer forms in breast tissue, most commonly in the cells that line the milk ducts. In the UK, it is the most common form of cancer and affects 1 in 7 women in their lifetime.

Breast cancer can be detected when symptoms form. These include a lump or thickening in the breast or armpit, skin changes (such as dimpling, puckering or redness) and nipple changes - including fluid leaking from the nipple or a change in the shape and position of the nipple. 

Breast cancer can also be detected by breast screening in women without symptoms. Breast screening is routinely offered to women between the ages of 50 and 70 years old in the UK and involves having mammograms (a type of x-ray) taken of the breasts.

What is Metastatic Breast Cancer?

When breast cancer spreads beyond the breast and armpit it’s called metastatic breast cancer. Common sites for breast cancer to spread to include the bones, lung, liver and brain. When breast cancer becomes metastatic it is no longer curable, but in many cases, there are a number of effective treatments available to control the cancer and prolong life.

What Age Range is the Disease Most Commonly Detected?

Like most other cancers, the most important risk factor for developing breast cancer is older age. This is the reason why breast screening is offered after the age of 50.

However, it’s still possible for younger women to develop breast cancer. It’s important to understand that there are lifestyle factors and dietary factors that can reduce your breast cancer risk at any age. Breast cancer risk can be reduced by maintaining a healthy weight, exercising regularly and reducing alcohol consumption.

When she was first diagnosed, Olivia Newton-John underwent a partial mastectomy, chemotherapy and breast reconstruction. Are there additional new ways that you can treat breast cancer?

When breast cancer presents early, the first line treatment is most often surgery. Surgery can be the removal of the cancer with a margin of normal tissue around it - known as a ‘wide local excision’ - or removal of the entire breast, which is called a ‘mastectomy’. In most cases, a procedure is also performed in the armpit to check whether the lymph nodes contain cancer cells. If the lymph nodes contain cancer, the tissue in the armpit containing the lymph nodes is removed. This is called an ‘axillary clearance’.

Depending on the nature of the cancer and the type of surgery that has taken place, additional treatment after surgery may be required including radiotherapy, chemotherapy, antibody therapy and drugs that block or reduce oestrogen in the body.

Are there any Complementary Therapies or Modalities that are Effective in Treating the Disease?

We recommend that patients follow conventional medical treatment for their breast cancer as these treatments have the strongest evidence to support their effectiveness. However, complementary therapies can be very useful to support the side effects of conventional medical treatment such as menopausal symptoms. These treatments include acupuncture, hypnotherapy, massage and meditation.

If a Patient has a History of Breast Cancer, how Often should they Attend a Screening?

After breast cancer treatment, a patient is normally followed up for a minimum of five years with breast imaging performed every year. After five years, if a patient is of breast screening age (over 50 years old), they will return to the three yearly mammograms in the NHS breast screening programme.

What Impact can Early Detection have on the Prognosis of Breast Cancer?

When breast cancer is detected at an early stage, it has not spread and can therefore be removed surgically. Additional post-surgery treatments such as radiotherapy, chemotherapy and hormone-blocking treatments further reduce the chance of the cancer returning. This means that cancers detected early have a very favourable outcome and patients can live a normal life after full treatment.

Are there any New Technologies that can Detect Breast Cancer in its early Stages and how Efficient are They?

Mammograms performed during breast screening can be very effective at detecting early breast cancer. Mammograms can detect breast cancer at a pre-cancerous stage when it cannot be felt.

Cancers detected at this stage have an extremely good outcome.

Modern digital mammogram machines and special types of mammogram machines that take numerous images of the breasts at different levels (known as ‘tomosynthesis’) produce high-resolution images that can be very effective at demonstrating breast cancer at an early stage too.

Being Breast Aware

The triple assessment at New Victoria Hospital’s One -Stop Breast Clinic includes:

  • A clinical breast examination
  • Mammogram, ultrasound, or both
  • Fine needle aspiration or needle core biopsy if appropriate

It's sensible to examine your breasts from time to time checking for anything unusual. Even though most lumps are not cancerous, if you find a lump in your breast or notice any of the following changes you should arrange to see your GP or a Breast Specialist New Victoria Hospital’s One-Stop Breast Clinic as soon as possible.

  • Change in size of your breasts (after puberty is complete)
  • Dimpling or in-drawing of the skin (skin looks like the texture of orange peel)
  • Lumpiness or thickening
  • Newly inverted nipple
  • Bloodstained discharge from the nipple
  • A rash, often eczema-like, on the nipple or surrounding area
  • Swelling or lump in the armpit

About New Victoria Hospital

New Victoria Hospital is a private, charity-owned hospital based in Kingston upon Thames, Surrey and is one of the few remaining independent hospitals in the country. It has provided a high level of service to the local community for over sixty years and is frequently ranked by patients as one of the top private hospitals in London.

The Hospital is registered with and regulated by the Care Quality Commission (CQC) and is fully compliant with their standards. The current CQC rating for the Hospital is “Good”. The Hospital was proud to achieve this rating across all five categories – safe, effective, caring, responsive and well-led.

It is owned by parent charity The Victoria Foundation. This charity helps to transform lives where there is an opportunity to do so - either through medical provision or by ensuring that young people destined to become the future generations of doctors are not prevented from doing so through lack of finances.

Media Source and Further Information

Please contact: Juliet at JFPR Consulting Tel: 07931 363 502;



Increase in Non-COVID-19 Respiratory Infections Predicted this Winter

An increase in the number of non-COVID-19 respiratory infections should be expected this winter, say scientists. The warning comes following the results of a new study, published in The Lancet Regional Health – Europe,[1] which found that over 55% of respiratory disease hospitalizations during the pandemic’s peak were caused by non-SARS-CoV-2 infections.

The University Bristol-led study funded and conducted in collaboration with Pfizer Inc., as part of AvonCAP, is the first to compare the number of hospitalisations from respiratory disease infections caused by COVID-19 and non-SARS-CoV-2 infections.  

Using data from 135,014 hospitalizations from two large hospitals in Bristol between August 2020 and November 2021, researchers identified 12,557 admissions attributable to acute Lower Respiratory Tract Disease (aLRTD) with patients admitted with signs or symptoms of respiratory infections including cough, fever, pleurisy, or a clinical or radiological aLRTD diagnosis. Of these, 12,248 (98%) patients, comprising mainly older adults, consented to participate in the study.

Following further analysis, the team show that of the 12,248 aLRTD hospitalizations, 55% (6,909) were due to infection with no evidence of SARS-CoV-2, while confirmed SARS-CoV-2 infection only accounted for 26% (3,178) of respiratory infections. The remaining 17% (2,161) were due to infection with no infective cause.

Adam Finn, Professor of Paediatrics at the University of Bristol, Director of the Bristol Vaccine Centre at Bristol Medical School and lead of Bristol UNCOVER (Bristol COVID Emergency Research Group), said: “What is really surprising from our results is just how much other non-COVID respiratory infections there was during this time, other infections clearly didn’t just disappear and despite significant public health measures, including both vaccination and non-pharmaceutical intervention such as masks, our findings show there was still a high incidence of non-COVID-19 disease causing hospitalizations alongside COVID-19 patients.”

Dr Catherine Hyams, Post-Doctoral Clinical Research Fellow, Principal Investigator for the AvonCAP study and one of the study’s lead authors at the University of Bristol, added: “Our results really highlight not only the huge burden of respiratory infection on the NHS and other healthcare systems, but also how bad things may get this winter. It is therefore essential that appropriate healthcare planning and resource allocation is undertaken to care for patients with respiratory conditions, in addition to implementation of public health measures to reduce respiratory disease burden and improve patient outcomes.”

The study is part of AvonCAP, an ongoing collaborative surveillance project funded by Pfizer Inc., which records detailed information on every adult patient admitted to Bristol’s two large NHS hospitals with symptoms, signs and/or X-ray evidence of acute disease in the lungs.


  1. A Finn et al. ‘Incidence of community acquired lower respiratory tract disease in Bristol, UK during the COVID-19 pandemic: a prospective cohort study’ The Lancet Regional Health – Europe: Volume 21: 100473. October 2022.

Further Information

COVID-19 research outputs A full list of University of Bristol research outputs relating to the COVID-19 pandemic is available online.

Bristol UNCOVER Group In response to the COVID-19 crisis, researchers at the University of Bristol formed the Bristol COVID Emergency Research Group (UNCOVER) to pool resources, capacities and research efforts to combat this infection.

Bristol UNCOVER includes clinicians, immunologists, virologists, synthetic biologists, aerosol scientists, epidemiologists and mathematical modellers and has links to behavioural and social scientists, ethicists and lawyers.

Follow Bristol UNCOVER on Twitter at:

For more information about the University of Bristol’s coronavirus (COVID-19) research priorities visit:

Elizabeth Blackwell Institute is supporting COVID research  Find out more about the Institute’s COVID-19 research looking into five key areas: virus natural history, therapeutics and diagnostics research; epidemiology; clinical management; vaccines; and ethics and social science.

Support our COVID-19 research Bristol’s researchers are part of a global network of scientists responding urgently to the challenge of the coronavirus pandemic.

Find out how you can support their critical work

About the AvonCAP study The AvonCAP (community-acquired pneumonia) study from Bristol is a prospective test negative case control study of adult respiratory infection and vaccine-preventable pneumococcal disease in the context of COVID-19 admitted to two large NHS hospitals. The study is conducted in collaboration with and funded by Pfizer Inc. The study funder had no role in data collection, but collaborated in study design, data interpretation and analysis, and writing this manuscript.

Media Source and Contact

Please contact [Mon to Tuesday] or Caroline Clancy [Wed to Fri], email, mobile: +44 (0)7776 170238 at the University of Bristol Press Office.



In Fine Print: Study Sheds Light on Mechanisms Driving 1,2-Dichloropropane-Induced Cancer in the Printing Industry

Study finds that when exposed to 1,2-dichloropropane, cells show altered gene expression that induces cellular cascades promoting cancer.

1,2-dichloropropane (1,2-DCP) is a solvent used in the printing industry. It was linked to cholangiocarcinoma in 2013, when printing company employees exposed to 1,2-DCP were diagnosed with the cancer. To understand the genes influencing cholangiocarcinoma development, scientists examined gene expression profiles in co-cultured cholangiocytes and macrophages exposed to 1,2-DCP. They found DNA repair genes in cholangiocytes and cell cycle genes in macrophages were upregulated, yielding novel insights on the pathogenesis of this elusive occupational hazard. 1,2-Dichloropropane (1,2-DCP) rose to prominence when it was linked to the development of cholangiocarcinoma, or bile duct cancer, in the employees of an offset printing firm in Osaka in 2013. Thereafter, the International Agency for the Research on Cancer reclassified 1,2-DCP as being carcinogenic to humans, and many studies have since focused on occupational cholangiocarcinoma on exposure to 1,2-DCP.

Common cholangiocarcinoma develops in the cholangiocytes (or epithelial cells) of the bile duct and liver. On the other hand, occupational cholangiocarcinoma has markedly different features, such as the presence of non-characteristic precancerous lesions and inflammatory changes in the surrounding non-cancerous tissue. Research suggests that while 1,2-DCP primarily targets cholangiocytes, it indirectly damages their DNA in the presence of inflammatory cells called macrophages. However, the exact mechanism of 1,2-DCP-induced cholangiocarcinoma remains a mystery.

To solve this problem, in a new study, a group of researchers led by Professor Gaku Ichihara from Tokyo University of Science (TUS), identified the gene expression profiles of cholangiocytes co-cultured with macrophages and exposed to 1,2-DCP. Prof. Ichihara says,

“Our findings identified the upregulation of genes tied to DNA repair and the cell cycle in cholangiocytes and macrophages, respectively. This suggests that the DNA damage, cell proliferation, and ultimately neoplasia occurring in the bile ducts is likely driven by the altered cell function induced by the abnormal gene expression.”

In the study, published in the journal Scientific Reports (published online on 02 July 2022)[1] Prof. Ichihara, together with his colleagues Shigeyuki Shichino and Kouji Matsushimia at TUS, Kazuo Kinoshita from Shizuoka Graduate University of Public Health, and Sahoko Ichihara from Jichi Medical University School of Medicine, co-cultured cholangiocytes and macrophages that were exposed to varying concentrations of 1,2-DCP for 24 hours. The concentrations selected mirrored the occupational exposure of workers in a poorly ventilated environment.

Prof. Ichihara’s previous work had shown that in the presence of macrophages, 1,2-DCP induced the expression of activation-induced cytidine deaminase, which is a DNA-mutating enzyme, along with excess DNA damage and reactive oxygen species production in cholangiocytes. To delve deeper, the team used transcriptomics to study the gene expression patterns in the cells and identify the intracellular mechanisms driving carcinoma formation.

The data revealed that in the presence of 1,2-DCP, co-cultured cholangiocytes showed higher expression of base excision repair genes, whereas macrophages revealed upregulation of cell cycle genes.

“The upregulation of DNA repair genes suggests an increase in DNA damage as 1,2-DCP concentration increases. Furthermore, macrophages could proliferate at a given site following 1,2-DCP exposure. Since they play an important role in the regulation of inflammatory responses by releasing cytokines and signaling molecules, their overstimulation could result in the persistent production of these compounds which ultimately influence various pathological states and cancer,” explains Prof. Ichihara.

The implications of the study are far-reaching in the fields of environmental toxicology and occupational cancer prevention. The team’s findings show that it is possible to pinpoint how potential carcinogens promote cancer without directly damaging DNA. Prof. Ichihara and his team are confident they can build on their findings and design further studies to fully understand the cross talk between cholangiocytes and macrophages and elucidate the mechanisms behind the erroneous DNA damage repair in cholangiocytes.


  1. Abigail Ekuban, Shigeyuki Shichino, Cai Zong, Frederick Adams Ekuban, Kazuo Kinoshita, Sahoko Ichihara, Kouji Matsushima & Gaku Ichihara. Transcriptome analysis of human cholangiocytes exposed to carcinogenic 1,2‑dichloropropane in the presence of macrophages in vitro. Scientific Reports 12: (11222). 2 July 2022. DOI:

About The Tokyo University of Science

Tokyo University of Science (TUS) is a well-known and respected university, and the largest science-specialized private research university in Japan, with four campuses in central Tokyo and its suburbs and in Hokkaido. Established in 1881, the university has continually contributed to Japan's development in science through inculcating the love for science in researchers, technicians, and educators.

With a mission of “Creating science and technology for the harmonious development of nature, human beings, and society", TUS has undertaken a wide range of research from basic to applied science. TUS has embraced a multidisciplinary approach to research and undertaken intensive study in some of today's most vital fields. TUS is a meritocracy where the best in science is recognized and nurtured. It is the only private university in Japan that has produced a Nobel Prize winner and the only private university in Asia to produce Nobel Prize winners within the natural sciences field.

About Professor Gaku Ichihara from Tokyo University of Science

Dr Gaku Ichihara is a Professor in the Department of Occupational and Environmental Health, Faculty of Pharmaceutical Sciences at the Tokyo University of Science. He completed his doctoral studies in 1993 at Nagoya University. He joined Tokyo University of Science in 2014 where his research focuses on preventing environment-induced disorders in humans. The Ichihara lab investigates the mechanisms of toxicity using human studies, experimental studies, and in vitro systems. Prof. Ichihara is a member of the committee overseeing occupational exposure limits at the Japan Society for Occupational Health, and has worked with the WHO International Agency for Research on Cancer.

Funding Information

Funding for this study was provided through a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (17H06396).

Source and Media Contacts

Indrani Das <>

Hiroshi Matsuda

Public Relations Division, Tokyo University of Science



What’s the Secret of the 15% of Brits Who’ve Never had Covid?

Many people have contracted Covid at least three times, yet around 3 in 20 Brits have never caught it at all. A leading testing expert reveals whether vaccines, lifestyle or blood group are the key to their escape.

As the UK prepares to be the first country to launch a top-up Covid jab which includes the Omicron variant, why is it that some people have suffered several bouts, while others have never caught the virus? Around 15% or more Brits are thought to have entirely escaped the disease.

The leading testing expert, Dr Quinton Fivelman PhD Chief Scientific Officer at London Medical Laboratory, says:

“There is a fast-growing number of people who have had Covid three times or more, including myself. Even if they have only suffered a relatively mild case, it’s still unpleasant, often causing temperatures, headaches, aches and pains and other symptoms.

“All those people who are fed-up with having caught the virus several times will welcome the fact the UK is the first country to approve a vaccine covering both the original coronavirus strains and the newer Omicron variants. It’s likely that a top-up jab which produces antibodies against Omicron will reduce the number of people catching – or re-catching – the disease, as well as reducing the severity of symptoms for those who do fall ill.

“The new Omicron jab has come none-too-soon, so many people are now suffering repeated Covid infections. That’s because the new Omicron BA.4 and BA.5 sub-variants do not produce as high an immune response as the previous strains, so re-infection is more likely to occur. Higher levels of antibodies are important to neutralize the virus, stopping infection and limiting people transmitting the virus to others.

“However, as well as successful vaccines, there could be two further reasons why some people have escaped every form of Covid so far. Lifestyle is thought to play an important part in reducing our chance of catching the virus, while, somewhat unexpectedly, what blood type we are also looks to be playing a part.

“In terms of lifestyle, obviously those people who are cautious about visiting crowded areas, continue to wear masks on public transport and limit indoor socialising are less likely to catch the virus at all, or at least reduce the frequency with which they catch it.

“Lifestyle is more than just exercising caution; however, our socio-economic status is a big factor. It can influence how well we can afford to eat, our ease of access to healthcare, the number of vitamins we take, etc. Age and health are also key factors. On the positive side, older people may be less likely to visit crowded clubs and festivals, limiting their potential exposure to the virus. On the other hand, if you’re older or have an underlying disease like cancer, diabetes, or heart disease, you’re more likely to develop a severe illness if you do catch it.

“There is now strong evidence that another factor entirely beyond our control is also at play. There have now been too many studies to ignore which reveal that people have a lower chance of people of catching the virus, or developing a severe illness, if they have blood group O.

“It was a 2020 study published in the New England Journal of Medicine [1] that first  caught headlines with its conclusion that blood group O is associated with a lower risk of acquiring Covid-19 than non-O blood groups (i.e. A, B, AB groups), whereas blood group A was associated with a higher risk. Newspaper coverage claimed people with blood type O were 35% less likely to be infected than other blood groups. Conversely, it was reported that people with blood type A had a 45% increased risk of being infected.

“This result has been largely reinforced in an analysis of the nine most recent Covid blood type studies. This study revealed eight out of the nine papers found an association between blood type and susceptibility to Covid infection. Again, people with blood group O showed the lowest instances of catching the virus or developing more serious symptoms or death. As with the earlier study, some of these papers also linked group A to increased susceptibility and severity.

‘Our blood group is determined by the genes we inherit from our parents and is based on which proteins are on the surface of our red blood cells. According to the NHS, blood group O is the most common blood group. Almost half of the UK population (48%) has blood group O. And 36% of the population has O+, the most common type.

‘It's easy to discover your blood type by donating blood or taking a test such as London Medical Laboratory’s new Blood Group test which is available in over 50 clinics, pharmacies, and health stores across London and nationwide. ( It will tell you to which blood group you belong (A, B, AB or O) and whether you are RhD positive or RhD negative. Some studies have found being RhD negative can also mean greater Covid protection.

‘However, that doesn’t mean to say that, if you do know your blood group, you should relax entirely if you are group O or panic if you are A. By far the most important factor is the number of antibodies you carry, from inoculations and previous infections, together with your level of overall health and fitness.

‘If anyone is concerned about their own immune response to the jabs and how well they continue to produce antibodies, the new generation blood tests available from London Medical Laboratory are highly accurate, quick and simple to carry out, either at home through the post, or at one of the many drop-in clinics that offer this test across London and the UK. For full details see:


  1. Dr Ellinghaus, Degenhardt and Drs. Valenti, Franke, and Karlsen – The Severe Covid-19 GWAS Group. Genomewide Association Study of Severe Covid-19 with Respiratory Failure. N Engl J Med ; 383:1522-1534. 15 Oct 2020. DOI: 10.1056/NEJMoa2020283.

Further Information

London Medical Laboratory’s Chief Scientific Officer, Dr Quinton Fivelman PhD is available to supply exclusive written comment or for interview. To contact Dr Fivelman, or for more information, please email London Medical Laboratory’s Head of Public Relations, David Jinks MILT, at


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