Iceland is famous for its volcanoes and its hot springs
But Icelanders are about to become the most studied people on the planet,
because their blood has led to a discovery that casts a new light
on one of the West's biggest killers: Cancer
Like the people enjoying these hot springs, you may feel fine,
but the truth is you've probably no idea how well you really are
Inside your body at this very moment
cells are fighting, multiplying and dying
Among them may be cells which could kill you,
as they kill millions of people worldwide every year
They are cancer cells
Understanding and controlling them could help curb a great human scourge
and teach us more about the secrets of life itself
More than one in three of us will get cancer,
which is why some of the most urgent and exciting research in medicine today
is aimed at combatting this disease
We'll find out more about the causes of cancer,
how it is linked to ageing,
and how the reason for both could lie in the air that we breathe
We'll discover how extraordinary cancer is,
how it lives inside us like a parasite,
How it can grow its own life-support, and how it can set off
and travel through the body to new sites
But we'll Also discover how to fight it by
exploiting the remarkable defence systems of the human body
We'll take a first-hand look at advances in cancer treatments
by following four pioneers: Jeff Allen who's trying a cancer vaccine;
Donald Hardy, who's undergone gene therapy;
Brian Newton, who's searching for a miracle;
And Diane Ranson, who's hoping an experimental drug
will work where conventional treatments have failed
It is frightening when you know it's inside you and it's-
it's multiplying and and building up, and you don't even know it's there
So deep-seated inside my body that it's not one that they can operate on
and it isn't a tumour that they have any medicine or drugs for at the moment
A year ago, Diane, a teacher, went into hospital for a routine hysterectomy,
but her surgeon found tumours in her womb and ovaries
He cut most of the cancer out
but she was unlucky:
Some had spread to lymph glands in her abdomen
This is a three-dimensional view of the new cancer
It's that huge dark mass in the centre of Diane's body
It's now so big that it's starting to squeeze out healthy tissue
I think it worries me, about the future,
because I don't know what's going to happen in the future
l- I suppose I haven't asked those questions about what could possibly happen
because l- I don't think I want to know that,
because I don't want to worry and dwell on those things
I just want to live for today and...
I think it's living with it, it's not dying with it
it's living with it and that's how I think about it
Diane has tried chemotherapy, but it didn't work for her,
so she's volunteered to try an experimental drug
Like many new cancer treatments
it's based on a naturally occurring substance
Our world is full of creatures
That make exotic poisons and unusual chemical
corals, sponges, sea squirts and sharks all produce substances
that are being tested as potential drugs
But for every one that works, there are many that don't
The search for new drugs to treat cancer is one of trial
and error with many false leads and dead ends
What looks promising in the laboratory often fails in humans,
and many exciting leads end up precisely nowhere.
But anti-cancer drugs can crop up in the most unexpected places
For centuries, people have known yew trees like those in this maze are poisonous
just a handful of their leaves could make you extremely ill
But from yew leaves we now get two highly effective anti-cancer drugs:
Taxitea and Taxol
Encouraged, cancer researchers are scouring
the earth for other drugs with natural roots,
and in Africa they've found one
For generations, Zulu witch-doctors have used
the bark of the African bush willow as a medicine,
and their warriors have used it as a poison to coat their spears
Recently, research has discovered that
the bark might have another use: Killing cancers.
It does this by attacking their blood supply
This remarkable picture shows
a huge mass of blood vessels growing in and around a cancer
As they grow, cancers develop their own blood supply
So one way to stop the cancer is to attack their tiny arteries
In laboratory tests, a drug made from the bush willow did just that
It made the walls of the minute vessels collapse so that
blood flow came to a complete halt But will it work in humans?
At Mount Vernon Hospital near London, they're about to find out
This is Diane's first day of treatment with the bush willow drug
Everything all right? Yes, yes
You can feel it? Does it feel cold?
I can feel it, yes, it's just cold
No abnormal sensations, At all? No
Bit disappointing, she says!
No, no, I'd far prefer it to be a total anti-climax
Yeah, yeah. The more boring it is the happier I am!
They first give the drug then wait to see if there are serious side-effects
That's the exciting bit over Right, phew!
Relief...
You didn't quite believe me that any side-effects that were going to happen
Were likely to happen later True, right, OK
It wouldn't surprise me if it takes about an hour,
because if the drug works the way we think it works,
it's got to start affecting the actual cell shape of the cells
that line the blood vessels, and that's gonna take a bit of time
Many drugs that work in the laboratory fail when used on
patients because they're too toxic
Diane and her doctors should find out within hours whether the drug is working,
or whether it is doing more harm than good
Diane has been told that the drug should reduce the drug supply to her tumour,
and if that happens it might kill the cancer
All she can now do is to wait and hope
I've got a tenderness in the base of my stomach it's really sore
I haven't had any pain-killers yet but I'm- I'm-
they're just going to get me a pain-killer for it
This bit's a bit frightening because you don't know what's happening now
something is obviously happening but I don't know what
starving her cancer of the blood it needs would be expected to cause pain
so the early signs are encouraging
I was hoping that we would get pain in the tumour,
because if you imagine when you do exercise and you don't get enough blood supply
to your muscle you get pain,
because that's not enough oxygen, I would expect the same
if we're getting a really good reduction in blood flow in the tumour
Diane is given pain-killers while they wait to see if the drug is working
The treatment is designed to kill her cancer by depriving it of oxygen
But what is it that triggers cancers like Diane's in the first place?
The answer, bizarre though it sounds, may be linked to oxygen
We breathe in and out 23,000 times a day and with each breath
we inhale a gas
which is both corrosive and explosive:
Oxygen
Every breath we take
brings oxygen to our cells where it is consumed and generates power
It is carried from our lungs in the blood to every part of our body
Human cells need oxygen to produce energy
but in doing this they also make dangerous chemicals known as free radicals
Free radicals damage our cells
and the more we produce, the more damage they do
And sometimes we are our own worst enemies
Smoking, sunburn and pollution can all speed up the release of free radicals
As the years pass beyond childhood
we see increasing signs of this free radical damage:
It is called ageing
But free radicals do more than just age us:
They go right to the heart of cells and damage the DNA
This can lead to the growth of abnormal cells and eventually to cancer
But there is a way to slow free-radical damage down
An apple a day is supposed to keep the doctor away
So why is eating fruit good for us?
Plants need oxygen to grow
so they've evolved sophisticated defences against its dangers:
They make anti-oxidants like vitamins that mop up free radicals
And a diet rich in fruit and vegetables
transfers some of the benefits to us
reducing the risk of many cancers
But once a tumour actually takes hold and begins to grow
a change of diet is probably not going to help
In Philadelphia, they're developing novel ways to attack advanced cancers
Brian Newton has travelled to America to see if he can get a treatment
they're pioneering called gene therapy Brian has mesothoeviona,
A form of cancer caused by exposure to asbestos
Breathing in asbestos is extremely dangerous
The fibres travel down into the lungs irritating their delicate tissue
The fibres then trigger this particularly aggressive and generally incurable form of canc
But Brian refuses to give up
The most important thing to me is I don't want to die
I don't want to die, I don't want to be an invalid,
I want to try and maintain some quality of life
I mean, inevitably, all of us have got to die;
I don't want to end my days being an invalid, bedridden
I think quality of life's the important thing that I'm seeking
Brian is a keen sailor
but these days he's seldom well enough to take his boat out to sea
He's pinning his hopes on gene therapy
because chemotherapy or surgery will only give temporary relief,
and he's looking for a treatment that will make him better
I wonder if it's getting worse? I haven't considered that as an option
I think if I was to start thinking down
down that route,
that would be tantamount to beginning to give up
I'm not a quitter.
But Brian is racing against time
Although he was only diagnosed three months ago,
his cancer has been spreading inside him for much longer
By the time a doctor can detect most cancerous growths,
they are already made up of billions of cells
But every cancer begins when individual cells start to divide uncontrollably
Ordinary cells have a limited life-span, dividing perhaps fifty times in all,
but cancer cells can turn off this biological clock and multiply indefinitely
Eventually, a massive ball of cancerous cells develops, fighting with healthy tissue for life
It all starts when the damaged DNA of a single cell sets off
an unstoppable chain reaction
Gene therapy tries
to get to the heart of cancerous cells like this and stop them from dividing
Brian's rapidly growing cancer will severely test this therapy
And there's another problem:
His chest is so full of fluid it's making breathing difficult
He has to go straight from the airport to the emergency room
OK, so put some in there
OK, so a lot of pressure right about the rib
Three and a half litres of liquid are removed before his breathing eases
Brian has a night to recover
before he meets the doctor in charge of the gene therapy trial
You would be a - from what I can tell a good candidate for the gene therapy programm
And I think that you have to understand that if you consider our programme,
there are no guarantees,
and there-all that this is safe
we are unlikely to harm you
we are extremely unlikely to shorten your time here on earth
Think of it down the road, gene therapy
may be the mode of therapy for treating cancers
We are not there yet
and I think that anyone who expects that out of these early trials is expecting too much
It's exciting, we have to do these trials
it's the only way to learn,
so you are in a sense a guinea pig
but you'll be guinea pig number 33 or 34, not number 1,
but I can introduce you to number 1, who's still alive and kicking
He's still alive? Yes.
Number 1 is very much alive and living in Florida
He's Donald Hardy
Like Brian, he also had Mesothoevioma
That was six years ago
Then he became the first person in the world
to go through the gene therapy trial in Philadelphia
Everyone patted me on the back and told me I was a pioneer
and a brave individual to do this and I should be commended etc
And I didn't feel like a special person
- I just felt this is something that I needed to do for myself
Donald's treatment amounted to planting a sort of time-bomb inside his cancer
First, doctors injected his chest with a virus carrying a killer gene
Then the gene was activated with a drug to selectively
kill all rapidly dividing cells
Gene therapy is so experimental, that the success of
their first attempt surprised even Donald's doctors
Gene therapy is in its infancy
I liken it to the development of the aeroplane where we're the Wright brothers,
we're Kitty Hawk and we have this rickety old kite with a automobile engine
strapped to it trying to fly over the sand-dunes,
and we're a long way from having the 747
It will take time to get there but I think it's going to revolutionise
the way we treat cancer in the next twenty to thirty years.
After the gene therapy, I kept asking the doctor: How am I doing?
And the common response was: We don't know
And I'd say: What d'you mean 'you don't know'?
He says: We've never done this before on a human
so you tell me how you're doing
I said: Oh, I feel all right, so you tell me is that good or bad?
He said: That's good
As well as the gene therapy, Donald also had some experimental surgery
He doesn't know which did the most good and he doesn't care
What he does know is that for now he has survived a fatal disease
Now no one will tell me I'm cured
but they tell me I'm doing really well and they're pleased with my progress
and of course I'm very pleased with my progres because I'm still here sitting in the sun in Flori
I didn't expect anything
I just- I'd hoped, and I can't give up hope
Many people hope to get on the gene therapy trial there's a waiting list
Dr. Sterman advises Brian to have surgery in the meantime
I haven't ruled out surgery or chemotherapy completely
I think they're quite invasive treatments not to be taken on board lightly
Let me tell you that the tumour is progressing
This is not the sort of thing where you say: Well, I'll try the gene therapy,
if that doesn't work I'll try surgery in six months
Six months - surgery will no longer be an option
You are progressed likely to the point where
You-it will not- I wouldn't even bring it up
I felt a bit numb and that the windows were closing in on me
I think in the back of the my mind
I knew- I knew it myself
But to have someone tell you, it's- it numbs the brain a bit
It's not what we want to hear
The problem I'm faced with is because
I don't know when the treatment's going to be available,
I may end up with no options
So that's frightening, that's frightening
Back in England, it is the moment of truth for Diane Ranson
She's having a scan five hours after taking
the experimental drug derived from the bush willow
Just going to start the scan now, Diane If you can keep nice and still for me...
The drug won't have killed the tumour
but if it's going to work at all it should at least
have reduced the vital blood supply to the cancer
Well, I've just seen the MRI scan and I have to say it's very exciting
Oh, thank goodness for that
Basically, there's virtually no blood flow any longer to the tumour, so...
That's marvellous
So it's done what we wanted it to do
I mean, obviously what I mean, that's not the what
we don't know is whether it will be maintained...
Yes, of course
...so obviously it's important to see what the scan shows tomorrow
But it all fitted, I mean, the fact that
you got all this pain would go with that, so...
That's good news
So let's keep our fingers crossed, yeah
Er, but obviously we'll be continuing with the weekly treatment
I think you can cope with that bit of pain, can't you?
Oh, yes, yes, yes I can
Knowing that probably it's going to do some good as well, is doing good
OK, that's great Marvellous, thank you
Well, that's good news, isn't it?
The scan looks dramatically different
and to have an effect on the scan within five hours...
and it fits with the pain and the change in blood pressure,
and it looks as if the drug might well be
working the way we hoped it was going to work
Well for me it's incredibly exciting
'cause this is what we've been working
at for years to try and find a drug that can block up the blood supply
and it looks as if we've now got one that really seems to do it in humans,
so that's- that's really the culmination of
a huge amount of effort for people around the world
Wouldn't it be marvellous if I'd made the break-through? Be great
Stopping advanced cancers growing is extremely important,
but it would be even better if we could spot them early
Up near the Arctic Circle they've made a
remarkable discovery which helps do just that
It's been made in rocky volcanic Iceland What they've been looking for here
are clues as to why some people seem far more vulnerable to cancer than others
Their search has been greatly helped by the Icelanders' unusual passion for history
When the first settlers landed on these barren islands, land rights were everything
They began to write down their family histories
so that their children and their children's children could claim their inheritance
In a land where few real trees grow, family trees have become an obsession
The famous Icelandic Sagas document
the exploits of the early norsemen who first arrived on these rocky shores
Nearly every saga begins with a long family tree
It's a tradition continued today
where many modern Icelanders keep family records going back centuries
A thousand years of plagues, epidemics,
earthquakes and volcanoes have really whittled down the population
Survival of the fittest has meant survival of only a few blood lines
The result is something unique:
A nation made up of 270,000 of the most genetically similar people on earth
Icelanders are effectively one giant family,
and that's what makes them so interesting to
researchers studying how cancer can be passed down the generations
Teacher, Asgerdur Olafsdottir, can trace her family tree back several hundred years
but it is a story full of tragedy
My grandmother, my mother's mother, she got breast cancer and died from it
She had two daughters - my mother and her sister -
and they both got breast cancer And my father got pancreas cancer,
and then my only brother, he got prostate cancer
And both my parents and my only brother they died from cancers
in twenty months' period And one year after my brother died,
I got breast cancer myself so it's
it's quite a story Yes
Asgerdur's awful family history is not that unusual in Iceland
This country has some of the highest rates of breast and prostate cancer in Europe
Asa Jonsdottir lives on the opposite side of Rekyavik
She's already had two operations to remove breast cancer
Many of Asa's closest women relatives have developed breast cancer
Yes, my grandmother, my father's mother and all her sisters
But it is not only the women who have been unlucky
The men in Asa's family have been just as badly hit: By prostate cancer
That's my father and his brother, brother of my grandmother
and my grandmother's father- he also
he was- also had a prostate cancer
So what's going on here?
Why have Icelanders been so badly hit by these two cancers?
Asa and Asgerdur hadn't met until we introduced them
But if you trace their family trees back far enough,
you discover these two women are related
The vulnerability to cancer which has cursed both families appears
to have been handed down from a common relative nine generations ago,
and he probably inherited it from a single
settler to the island hundreds of years before that
By taking blood samples from living members of families like this,
scientists have discovered exactly why these people get so much cancer,
and the answer is surprisingly simple
The breast cancer that has plagued Icelandic
women is the result of a shared genetic fault
This thermal image shows a hidden cancer
It's the blue patch on the left breast
Such a cancer would have started with a damaged section of DNA
Most of us have repair genes to fix such damage
but some Icelandic families lack a crucial repair gene
Women with faulty repair genes have up to an 80% chance of developing breast cancer
This leads to difficult choices:
If a genetic test is positive
should you have perfectly healthy breasts removed
as a possible preventative measure?
Asgerdur has already had a mastectomy
so it's not a choice she needs to make
But for those with the defective gene,
there's a fifty-fifty chance they'll pass it on to their children
I've only got the one son and he's thirty years old,
and he has promised his mother one thing:
That after forty he will get some blood tests
to find out if if he could possibly have this
I have a fish, Robert
I've got a fish
The defective gene that leads to breast cancer in Iceland
has also been found in many other populations around the world
And, encouraged by this, they're widening the net
A huge research effort has begun involving the entire Icelandic population
to find other genes that make people vulnerable to other common cancers
Such knowledge would certainly help early detection and improve chances of survival
Uncovering cancer-causing genes
tackling tumours with gene therapy or cutting off their blood supply
could all have a dramatic impact on cancer medicine in the future
But there is and even more exciting treatment on the horizon
- one that harnesses the body's own natural ability to seek out and destroy disease
it's the immune system
Just as birds fiercely repel any threat to their nests,
our bodies have a powerful natural defence against invaders
The immune system is one of the most potent
weapons we have when it comes to tackling cancer
An approach which harnesses the immune system is being tested on
a range of cancers including the often fatal skin cancer, malignant melanoma
Skin cancer is such a rapidly growing threat that countries round the world
have launched shock public health campaigns to try to ram home the dangers
All my friends used to say the first time you go to the beach get a good burn, you know
you'll tan faster, so you know, a tan was considered healthy
And none of us knew the potential ramifications of over-exposure to the sun
About three years ago, I noticed a red spot at the end of my nose
Skin cancer - that won't happen to me, it never occurred to me
Life is very precious to me now
Almost losing it makes that very very clear
Jeff Allen knows how it feels to look death in the face
When he was told he had a malignant melanoma
he was also told his prospects were very bleak
He was afraid he wouldn't live to see his children grow up
It all began with something which At the time seemed insignificant
We went on holiday to Cornwall,
And while we were there Dawn spotted a mole on my lower back
which she thought had changed, she thought it looked different
When we got home I went to the doctor's
the doctors had a look at it and said, yes, you need to see someone at the hospital
Hospital had a look and said, yes it doesn't look too good, we'd better have it removed
and do a biopsy and find out what it is And it was indeed- it was skin cancer
But even at the time we didn't- I didn't think it would be anything
- I just thought they'd say, it's just a mole, it's changed,
we'll take it- I didn't expect anybody to say that it was cancer
At the time, Dawn and I were hoping to have another child - we'd just got the one
They said wait a year before you try again, see if everything's OK
Which we did - I went back every month or so, and everything was fine
and so after a year everything was clear
and so we went for another child
Dawn got pregnant more or less straight away
and about that time they discovered that the skin cancer had come back,
it had in fact moved to under my right arm
Jeff's original cancer may have been removed, but it had already shed its seeds
These had escaped and begun to travel around his body
Cancer cells travel through the body's internal highways,
carried in the blood and in the lymphatic system
Many of these cancer cells are caught and killed by our immune system
But if a single one escapes, it can grow into a whole new cancer
Jeff's spread to the lymph glands under his arms
Then the cancer started growing in his bones
I think about a year after that, now, they discovered that it had actually
moved into my spine and the third rib down on my lower side,
so obviously I realised then that things had taken a turn for the worse
Having got into his ribs, the black patches of tumour started to eat away at his bones
With nothing left to lose
Jeff tried an experimental treatment - a cancer vaccine
Most cancer vaccines consist of active live bacteria or treated cancer cells
These are injected to try to arouse the immune system
This is not suitable for every cancer
But what the doctors are hoping to see is this
The irregular shaped cells are cancer cells;
the fuzzy-looking things attacking them are the white blood cells of the immune system
they're literally eating the cancer cells away
I never worried about being an experiment at all really:
I think you've got to clutch at what you can get
This seemed like something worth - worthwhile,
worth trying, it had had good results in America, so yeah,
you've gotta go for these things - I think most people would, to be honest
Didn't think twice, really, did you? No. What choice is there really?
Jeff began fortnightly injections
At first, progress was slow
Then something remarkable happened
So effective was the vaccine
that not only did the cancer stop spreading, it actually started to disappear
Only months into his treatment, the cancer in his bones began to go
Since then it's just gone from good to better
Basically it started off well and it's just continuing
I'm not sure they'd ever say you're cured
But it is in regression, it's certainly going back,
the bones are re-hardening, they're all- they're all re-forming,
everything that was looking bad is looking better
so, no, you're not cured
but you're well on the way and you're certainly going down that path
Jeff is not unique:
Early trials suggest about half the patients
given cancer vaccines survive for five years or more
which for an advanced cancer of this type is impressive
Jeff has been exceptionally lucky
and there's no guarantee the vaccine will continue to work
New cancer treatments can take years to perfect
and for the patients who undergo these pioneer therapies,
the benefits may not be for themselves but for future generations
Two months after his visit to Philadelphia,
Brian Newton was offered a place on their gene therapy trial,
but by then he was too weak to travel
Is that sore when I press? No
Brian's tumours have now spread to his chest wall
They form a visible lump
Brian's now opted for a treatment he'd originally rejected: Chemotherapy
There isn't a huge amount there,
I think I can detect some fluid at the base there
D'you want to pop your things on now, please
It might have slowed down
Yup. We'll see
The world is very fast today,
And I think that people expect, if they hear about gene therapy,
that within a year or two it should be there and available
and in your local 'doc-in-a-box' around the
corner for treatment of the common cold or your pneumonia
And I think people don't have patience
It took many many years for anti-biotics to be developed
and I think it's gonna take many years for gene therapy to be effective
OK, you're not gonna feel any different
In the beginning, I didn't want to think about chemotherapy
and I didn't want to think about surgery
But you've got to do something
I'm not deluding myself that there is a cure available
one can only live in hope
Seven weeks have passed since Diane Ranson began her weekly treatment
She's found it very hard She's been feeling tired and weak
Today she's going back to hospital to find out if it's all been worthwhile
Although the drug cut the blood supply to the tumour, it wasn't enough
There's no doubt that it's had a dramatic effect on the blood flow through the tumour,
but I have to say the last scan we did didn't
how any actual reduction in the size of the tumour
Now my feeling is that it's probably
not fair to put you through another three lots of treatment
So the question is: What do we do next?
I think the first thing is we should see how you recover over the next week or two...
I think perhaps the disappointing thing is that it hasn't shrivelled up and disappeared
but um I think it's something I've sort of
thought through and probably come to that conclusion anyway
The bush willow drug hasn't worked for Diane,
but there are signs it could be working in other patients
In the meantime, Dr. Rustin offers Diane a place on another drug trial
Obviously it's unknown territory again
I know how this one has affected me,
I'll just have to see how that affects me
but I think given a break of a few weeks I'll be raring to go again
Diane started the new drug trial but her cancer rapidly progressed
and she died four months later
Brian, too, died during the making of this film
Donald Hardy continues to defy the odds, living out an active retirement in Florida
Jeff Allen is still free of his cancer
He has regular injections of vaccine to keep it at bay
For years, our main weapons against cancer have been fairly crude
but the treatments Jeff, Donald and Diane have been trying may change that
lt'll certainly be some time before they become routine,
but our increasing knowledge of genetics and our understanding of
how the body naturally combats cancer will be revolutionary
We shall probably never get rid cancer
but we will learn how to tame it