After studying mathematics and mathematical statistics at undergraduate and masters level, respectively, in 1981 Mike Hawkins moved to the Childhood Cancer Research Group at the University of Oxford where he began the establishment of national long-term follow-up studies of survivors of childhood cancer based on the National Registry of Childhood Tumours.
In 1998 Mike moved to the University of Birmingham to take up the post of Reader in Epidemiology and to establish the Centre for Childhood Cancer Survivor Studies funded by programme grants from Cancer Research UK and the Kay Kendall Leukaemia Fund. This led to the British Childhood Cancer Survivor Study, the largest ever population based investigation of adverse health and social outcomes among survivors of childhood cancer.
In 2010 Mike and his team established the Teenage and Young Adult Cancer Survivor Study, funded by Cancer Research UK, to investigate 170000 individuals diagnosed with cancer aged 15 to 39 years, in England and Wales, who survived at least 5 years from diagnosis.
In 2011 an international collaborative pan-European study was initiated, with substantial contributions from Mike and his team, involving most European countries, funded by the EC for five years, and which provides the largest ever investigation of the risks of causes of late deaths, subsequent primary cancers and cardiac conditions in survivors of childhood cancer.
Mike sits on several key national groups established by the National Cancer Research Institute, the National Cancer Intelligence Network and the National Cancer Survivorship Initiative.
Most years he gives invited lectures at international conferences and has advised on the potential establishment of national surveillance systems for survivors of childhood cancer in France, Germany and Japan.
Centre for Childhood Cancer Survivor Studies
The Centre for Childhood Cancer Survivor Studies was established in 1998 by the current Director, Professor Mike Hawkins, with quinquennial Programme Grant funding from Cancer Research UK and the Kay Kendall Leukaemia Fund to carry out the British Childhood Cancer Survivor Study. Epidemiology at the University of Birmingham, to which the Centre is a key contributor, had 60% of research activity rated as either world leading or internationally excellent in the most recent Research Assessment Exercise by the Higher Education Funding Council for England. Most children with cancer in the UK are treated by clinicians who are members of the Children's Cancer and Leukaemia Group (CCLG), formerly the United Kingdom Children’s Cancer Study Group (UKCCSG). As a result of the Director being a full member of this organisation, and also being a member of its Late Effects Group (with responsibilities concerning CCLG policy in relation to the care of survivors) excellent links are maintained with the clinicians treating and following-up children with cancer. There are also close collaborative research links with the Childhood Cancer Research Group, based at the University of Oxford, which maintains the population-based National Registry of Childhood Tumours. The Centre is well known internationally through its publications and attendance at most important meetings concerned with survivors of childhood cancer. Collaborative international studies of the adverse consequences of irradiation in childhood have been undertaken including data relating to survivors of the atomic bombs in Japan. There is an established international collaborative programme of studies of the incidence and aetiology of second primary neoplasms after childhood cancer in Britain and France. Good links exist with the Childhood Cancer Survivor Study which is ongoing in North America and co-ordinated from St Jude Children's Research Hospital in Memphis. An international collaborative study of the joint influences of radiation and genotype on breast cancer risk is nearing completion and was funded by the European Commission under the 6th Framework Programme. Just funded by the European Commission (7th Framework Programme) is a collaborative international study, PanCareSurFup, which is concerned with pan-European investigations of survivorship issues after cancer in childhood and young adulthood.
British Childhood Cancer Survivor Study (BCCSS) (www.bccss.bham.ac.uk)
The BCCSS is the national population-based study of survivors of childhood cancer in Britain which assesses a wide spectrum of possible health and other outcomes which may be adversely affected by childhood cancer or its treatment. It is based on an underlying cohort of 17981 individuals diagnosed with childhood cancer between 1940 and 1991 in Britain and who survived at least 5 years. The programme of work comprises 6 broad areas of investigation:
1) Long-term survival and causes of death occurring subsequent to 5-year survival to understand the long-term fatal consequences of childhood cancer and its treatment.
2) Risks and aetiology of second primary neoplasms after childhood cancer.
3) Health of offspring of survivors of childhood cancer to gain insights into the heritability of cancer and the potential adverse consequences of cancer treatments on subsequent offspring produced by survivors.
4) Long-term toxicities of major organs or bodily systems affecting survivors.
5) Social consequences of childhood cancer and its treatment.
6) Cancer in the siblings and parents of survivors of childhood cancer to provide further insight into the heritability of cancer.
The publications from the BCCSS may be reviewed at www.bccss.bham.ac.uk
Teenage and Young Adult Cancer Survivor Study (TYACSS)
The Department of Health, the National Institute for Health and Clinical Excellence and the National Cancer Research Institute have all identified a need and priority for accurate information concerning the risk of adverse health outcomes among survivors of cancer diagnosed in teenage and young adulthood. A large population-based investigation addressing a wide spectrum of fatal and non-fatal adverse health outcomes will provide an evidence base of importance for: counselling, educating and empowering survivors; creating and updating guidelines for clinical follow-up; preparing “survivorship care plans”; educating health care professionals; evaluating proposals for future treatment protocols from a risk as well as benefit perspective; assessing potential recalls to clinic of subgroups at substantially increased risk; providing a basis for more detailed aetiological studies.
The objectives of the research are to establish a database of almost 300,000 individuals diagnosed with cancer aged 15 to 39 years, in England and Wales, between 1971 and 2006. This database would be used to investigate the observed and expected risks of: specific causes of death, specific types of subsequent primary cancer and specific types of non-cancer morbidity (including cardiovascular, pulmonary, urological, hepatic and endocrine conditions). Evidence for the cure of specific types of cancer would also be assessed.
Record linkages between the established database and the national death and cancer registries, the Hospital Episode Statistics (HES) for England, the Patient Episode Database for Wales (PEDW) in Wales and the Myocardial Ischaemia National Audit Project (MINAP) will be undertaken.
From such linkages it will be possible to identify subgroups of patients (defined in terms of type of cancer, age at treatment, calendar year of diagnosis, period of follow-up, attained age and sex) at a substantially increased risk of specific adverse health outcomes.
The study, funded by Cancer Research UK in 2010, will be the first comprehensive investigation of fatal and non-fatal serious adverse health outcomes of cancer treatment in teenagers and young adults and the population-based design and large sample size would undoubtedly lead to a landmark contribution.
PanCare childhood and adolescent cancer Survivor care and Follow-up studies (PanCareSurFup)
This five-year programme grant from the European Commission for the first pan-European collaborative study of survivors of childhood and adolescent cancer was initiated in February 2011. It includes investigators from Austria, the Nordic countries, France, Germany, the Netherlands, Italy, Slovenia, Hungary and Switzerland. The broad objectives are:
1. Establish three adverse health outcome specific and retrospectively ascertained pan-European cohorts of survivors of childhood cancer within which the occurrence of late mortality, second malignant sarcomas and carcinomas, and cardiac events have been (or may be) systematically ascertained and validated. Focusing on carcinomas which are common in the general population after age 40 years and which are frequent among survivors including commonly observed digestive and genitourinary sites.
2. Undertake individual patient radiation dosimetry for individuals included within the nested case-control studies to obtain estimates of dose to the site of development of the adverse event and the corresponding site in the matched controls.
3. Estimate the absolute risk of each of these adverse health outcomes within the relevant cohort and compare observed and expected numbers of events where general population rates are available to enable the calculation of expected numbers. Of particular interest will be the comparison of observed and expected numbers among those aged over 40 years.
4. Execute three nested case-control studies of cardiac disease, second malignant sarcoma and second malignant carcinoma, respectively, and one cohort study of late mortality, occurring among survivors to determine the aspects of radiotherapy and type and dose of chemotherapy associated with increased risk.
5. Produce clinical follow-up guidelines for health care professionals, survivors and their families based on existing evidence and the results from this study in terms of the absolute risk available from the cohort studies and the relative risks in relation to risk factors from the case-control studies, as they become available. This includes issues related to transition from a paediatric to adult environment for on-going follow-up.
6. Establish partnerships between providers and survivor/parent groups to disseminate information about PanCareSurFup to the general public, to health professionals and survivor/parent groups; train health care professionals through conferences, workshops, booklets and web based information; empower and educate survivors to be as informed as possible concerning their long-term risks, and about general and specific health promotion measures that they can use to optimise their future well-being.
European Cohort Study of Survivors of Childhood Cancer
This study is organised jointly by Dr Florent de Vathaire at the Institut Gustave Roussy in France and Professor Mike Hawkins at the Centre for Childhood Cancer Survivor Studies in the UK. The area of investigation so far has been concerned with the risks and causes of second primary neoplasms. The product of this collaboration may be seen among our publications below at www.bccss.bham.ac.uk
This is an international collaborative study of the effects of genotype and radiation (and their interaction) in the aetiology of breast cancer co-ordinated by the International Agency for Research on Cancer and funded by the EU. Professor Hawkins is the co-ordinator and grant holder for the UK contribution relating to survivors of childhood cancer. Dr Reulen and Professor Hawkins are leading the international collaborative analysis of the nested case-control study carried out among childhood cancer survivors from throughout Europe.
Brabant, G., Toogood, A.A., Shalet, S.M., Frobisher, C., Lancashire, E., Reulen, R., Winter, D., Hawkins, M.M. (2012) Hypothyroidism following childhood cancer therapy – An under diagnosed complication. Int. J. Cancer, 130(5): 1145-1150
Rebholz, C.E., Reulen, R.C., Toogood, A.A., Frobisher, C., Lancashire, E.R., Winter, D.L., Kuehni, C.E., Hawkins, M.M. (2011) Health Care Utilization of Long-Term Survivors of Childhood Cancer: The British Childhood Cancer Survivor Study. J. Clin. Oncology, 29(31): 4181-4188
Haddy, N., Mousannif, A., Tukenova, M., Guibout, C., Grill, J., Dhermain. F., Pacquement, H., Oberlin, O., El-Fayech, C., Rubino, C., Thomas-Teinturier, C., Le-Deley, M-C., Hawkins, M., Winter, D., Chavaudra, J., Diallo, I., de Vathaire, F. (2011) Relationship between the brain radiation dose for the treatment of childhood cancer and the risk of long-term cerebrovascular mortality. Brain, 134: 1362-1372.
Reulen, R.C., Frobisher, C., Winter, D.L., Kelly, J.S., Lancashire, E.R., Stiller, C.A., Pritchard-Jones, K., Jenkinson, H.C., Hawkins, M.M. (2011) Long-term Risks of Subsequent Primary Neoplasms Among Survivors of Childhood Cancer. JAMA., 305(22): 2311-2319.
Tukenova, M., Guibout, C., Hawkins, M., Quiniou, E., Mousannif, A., Pacquement, H., Winter, D., Bridier, A., Lefkopoulos, D., Oberlin, O., Diallo, I., de Vathaire, F. (2011) Radiation therapy and late mortality from second sarcoma, carcinoma and hematological malignancies after a solid cancer in childhood. Int. J. Radiation Oncology Biol. Phys., 80(2): 339-46.
Taylor, A.J., Little, M.P., Winter, D.L., Sugden, E., Ellison, D.W., Stiller, C.A., Stovall, M., Frobisher, C., Lancashire, E.R., Reulen, R.C., Hawkins, M.M., on behalf of the British Childhood Cancer Survivor Study. (2010) Population-based risks of central nervous system tumours in childhood cancer survivors: the British Childhood Cancer Survivor Study. J. Clin. Oncology, 28(36): 5287-93.
Frobisher, C., Gurung, P.M.S., Leiper, A., Reulen, R.C., Winter, D.L., Taylor, A.J., Lancashire, E.R., Woodhouse, C.R.J., Hawkins, M.M. (2010) Risk of bladder tumours after childhood cancer: The British Childhood Cancer Survivor Study (BCCSS). BJU Int., 106(7): 1060-1069.
Reulen, R.C., Winter, D.L., Frobisher, C., Lancashire, E.R., Stiller, C.A., Jenney, M.E., Skinner, R., Stevens, M.C., Hawkins, M.M. (2010) Long-term Cause-specific Mortality among Survivors of Childhood Cancer. JAMA., 304(2): 172-179