"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 I" " I suppose I haven't asked those questions about what could possibly happen because I" " 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"