A local approach to world-leading cancer research

One of the key objectives of the National Institute for Health Research (NIHR) is to support UK research in areas that are internationally leading. It is little surprise that the NIHR chose to fund research in Manchester through the Biomedical Research Centre (BRC). The Centre’s director, Ian Bruce, talks about its approach to the prevention and earlier detection of cancer.

A combination of proven research excellence, established partnership working via Health Innovation Manchester (HInM) and a devolved healthcare budget means that the Manchester BRC is well placed to bring together multiple research themes relatively easily.

The aim is to ultimately develop better healthcare for the 2.9 million citizens of Greater Manchester – with one of its key focus areas being the prevention and earlier detection (PED) of cancer.

The Manchester BRC is hosted by the University and Manchester University NHS Foundation Trust (MFT) in partnership with The Christie, and Salford Royal NHS Foundation Trust. It focuses on research for which the city is already well recognised – including three cancer themes, one of which is PED.

Its role is to be a central catalyst in the Greater Manchester health eco-system, with a strategy that focuses on integrating research power and translational excellence, mapping our strongest clinical areas with the best enabling sciences.

As Director of the NIHR Manchester BRC, Professor Ian Bruce explains why the NIHR chose to invest in Manchester, and provides unique insights into the pivotal impact the PED cancer theme is playing across the city region.

Why cancer?

“When it came to identifying the best clinical research in Manchester, the NIHR looked around and found that cancer is clearly at the forefront,” Professor Bruce says.

“It’s got research beacon status at the University and Cancer Research UK has a massive presence. By working in partnership with the University and the local NHS trusts, there is a real opportunity to reach across the entire Manchester clinical infrastructure to undertake cancer research that will have a positive impact on patients’ lives.

“What’s more, if you can address cancer risk here in Manchester, not only will the local population benefit, but it’s also a fantastic way of selling what you do - or examples of best practice - to the world, because you’ve got a large population to work with.

Research with impact

Research coming out of the NIHR Manchester BRC is already making a difference.

Professor Gareth Evans’ research into developing multiple genetic markers for breast cancer screening has led to a better understanding of predicting breast cancer risk and knowing when to offer preventative treatments or screening to people who need it. It is also helping to reduce the amount of unnecessary screening and radiation exposure.

Manchester has also developed pioneering work in lung cancer screening. Dr Philip Crosbie’s research into the early detection of the disease has seen the screening process being delivered in more convenient and accessible locations, including supermarket car parks.

This is an example of how Greater Manchester, with its devolved health system, can lead the way by devising and executing research locally without the need for approvals by national authorities. The project has been so successful that it is now being rolled out by the NHS across the country.

Linking in with this, BRC researchers are also championing smoking cessation. The city’s lung cancer screening programme has helped to raise awareness of the health risks associated with smoking, prompting more people to change their habits.

This has generated huge health benefits downstream. If people stop smoking in their middle years, they reduce the risk not only of lung cancer, but also of chronic obstructive pulmonary disease (COPD), heart disease and rheumatoid arthritis.

New research funding

Some of the seed funding for the PED cancer theme has supported a lot of the early projects at the BRC, but, more recently, the focus has turned to leverage additional funding to take forward some of the new, emerging research projects.

“One of the things we want to see at the BRC is not only improved patient outcomes, but also more generally, better health and wealth for the nation as a whole,” says Professor Bruce.

“So, it’s about leveraging additional money to set up new funding platforms. This would involve, for example, two or three BRC colleagues coming together and approaching the likes of Cancer Research UK with a compelling joint bid.”

Benefits of cross-theme research

The fact that BRC researchers - whether they are focusing on cancer, musculoskeletal disease, dermatology, respiratory medicine or hearing health - work together in the same location means that they have been able to develop very close working partnerships, and share ideas and research outputs across illnesses.

“The BRC allows researchers to work off each other and say: ‘OK, if you’re doing that, what are the benefits on our side of the patch?’,” Professor Bruce explains.

“For example, some of the new cancer drugs with checkpoint inhibitors have quite significant adverse effects, sometimes triggering auto-immune or inflammatory diseases. So, our immunologists are now beginning to discuss with the cancer team how we can best address this.

“Many women who are treated with tamoxifen and other breast cancer drugs can get lots of joint pain, so we need to work out how they can stay on the drug and remain pain free.

“I think the fact that researchers sit together and discuss these issues across the BRC gives a different perspective on problems, which in turn allow us to develop new, innovative programmes of work.”

The Manchester approach

“Manchester has big, big strengths in partnership working and has the advantage of having a single, joined-up research community across numerous sites, including the Christie, The University of Manchester and the MFT facilities,” Professor Bruce says.

“This means that when you look at health informatics and data sciences, for example, there are people working across Manchester on laboratory data, population data and clinical data. Via the BRC, the research can line up more effectively - so we’ve got a range of people thinking across the problem.

“I think the cancer research community in Manchester is extremely forward-thinking, with researchers able to identify the next horizons. There’s also a great team science approach, and cancer research best exemplifies this.

“Manchester research is also embedded in and addresses the needs of the local community - particularly important in a city where there is significant health depravation and large pockets of underserved populations - so patient and public engagement and involvement in research is absolutely central to the Manchester way of doing things.”

An international reputation

Professor Bruce has little doubt about the city’s growing international standing as a leading research centre.

“Personally, I think Manchester is already leading the way in many aspects of clinical research and will continue to grow as one of the leading international cancer research centres - I’ve no doubt that we’re on that global trajectory,” he says.

“And, of course, the NIHR Manchester BRC has a pivotal role to play by acting as a catalyst for new ideas and bringing researchers together from across a range of disciplines to work more collaboratively.

“As Director of the Centre, one of my ambitions is that the Manchester research community continues to grow from strength to strength, so that we become a truly world-leading centre for research excellence.”