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Preventing Cancer: current public health issues and the Cancer Reform Strategy . Dr Chris Packham. Cancer Research UK website. What is the focus on prevention in the Cancer Reform Strategy?. Smoking Obesity Alcohol Excessive sunlight Infectious Disease

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preventing cancer current public health issues and the cancer reform strategy

Preventing Cancer: current public health issues and the Cancer Reform Strategy

Dr Chris Packham

Cancer Research UK website

what is the focus on prevention in the cancer reform strategy
What is the focus on prevention in the Cancer Reform Strategy?
  • Smoking
  • Obesity
  • Alcohol
  • Excessive sunlight
  • Infectious Disease
  • Raising awareness about prevention
  • Genetic services
smoking 30 all cancers
Smoking causes 90% of lung cancers

Smoking contributes to cancer of the oesophagus, larynx, pharynx, oral cavity, bladder, stomach, nose, liver, kidney, cervix, myeloid leukaemia

Male lung cancer incidence rates peaked in the early 1970s, reflecting the peak in smoking prevalence 20-30 years earlier and death rates now are falling.

Female lung cancer death rates will continue to rise to reach current male levels during the next ten years before falling.

One in four British adults currently smoke

Rates in some areas still what they were in UK 25 years ago

60-70% in some disadvantaged wards

Young women smoking more

NHS smoking cessation services help reduce smoking levels but by less than half of 1% annually.

The ‘ban’ may help to reduce rates by 1-5%

More is now planned on:

Smuggling and price increases

Tobacco advertising

Anti-smoking campaigns

Still a huge challenge

Smoking (30% all cancers)

Public Health Challenges

Some Facts

diet exercise and obesity 25 of all cancers
Red meat increase the risk of colon cancer by >10%

10% of UK diet is red meat

Salt increases stomach cancer risk in in countries such as Japan

UK Men consume twice the recommended salt intake

Saturated fat increases breast cancer risk. For each 1% increase in saturated fat intake, breast cancer risk may rise by 2%

Diet, Exercise and Obesity (25% of all cancers)

Public Health Challenges

Some Facts

diet exercise and obesity 25 of all cancers6
Obesity is a cause of cancer of the breast (10% of cases), colon (12%), kidney (25%), oesophagus (35%), womb (40%)

13,000 fewer cancer deaths a year if no-one was overweight (BMI >25)

Physical exercise itself reduces colon cancer risk whatever your weight

Reduces Insulin resistance - very important for BME groups

Fruit/veg. and fibre reduce cancer risk (colon, throat, stomach, bladder)

Two thirds of British adults are overweight and so increase their risk of cancer.

Only 1 in 4 of us exercises enough

Only 1 in 5 of us eats enough fruit/veg.

In BME groups, 2-11 year old children are more likely to be obese than the general population

General population: boys 15%; girls 15%

Pakistani boys 21%; girls 11%

African Caribbean boys 27%; girls 21%

Little evidence that NHS services alone can affect population obesity levels long term

Requires whole society efforts:

Schools exercise lessons

Food standards

Environments in which to exercise

Major Cultural change needed

Diet, Exercise and Obesity (25% of all cancers)

Public Health Challenges

Some Facts

hormones 15 of all cancers
The combined contraceptive pill increases the risk of cervical cancer but reduces the risk of womb and ovary cancer

Breast cancer risk reduces with the number of full-term pregnancies and overall with increased breast feeding

HRT increases the risk of breast, ovary and womb cancers

It is estimated that 2000 women a year may have contracted breast cancer over each of the last 10 years as result of historical use of HRT

Breast feeding rates are rising but remain low in more disadvantaged white communities

HRT use is falling rapidly, but the use of hormone treatments in family planning remains high and it is important we continue to be vigilant to spot any future associations between hormone treatments and cancer risks.

Hormones (15% of all cancers)

Public Health Challenges

Some Facts

Not a CRS current focus

alcohol 6 of all cancers
Alcohol increases the risk of breast, colon, rectum, liver and throat cancers

Smoking and drinking heavily in combination increases risk of cancers of the throat 80-fold, and account for 75% of all such cancers

Drinking more than 3-4 units a day increases cancer risks

Cancer of the throat increases particularly steeply with increasing alcohol intake

Alcohol up to a maximum of 3-4 units a day protects health by reducing the risk of heart disease in people with a high risk of it, so this only applies to people over the age of 40.

Alcohol has no other direct health benefits.

At the very least, 1 in three men and one in 5 women drink enough alcohol to increase their cancer risks.

It takes up to 16 years for the risk of alcohol-related cancers in a former drinker to fall to the level of someone who has never consumed alcohol.

Alcohol (6% of all cancers)

Some Facts

Public Health Challenges

infections 5 of all cancers
Hepatitis B and C are responsible worldwide for 80% of liver cancer deaths (500,000). In the UK, it is estimated that 60,000 may have Hepatitis B and 150-300,000 with Hepatitis C. Over 90% of those infected are first generation migrants from places where it is very common.

Identifying and treating these infections dramatically reduces the risk of liver cancer.

Human Papilloma virus (HPV) is a sexually transmitted infection and is the causal agent of almost all the 3000 annual UK cervical cancer and most anal and penile cancers.

Advanced HIV patients can get a blood cell cancer called Kaposis sarcoma and may also get leukaemia and liver cancer.

A bacterial infection of the stomach called H pylori is responsible for around 60% of stomach cancer but its frequency is reducing and it can be detected and treated.

The new HPV vaccination programme in teenage girls is predicted to reduce Cervical cancer by 70% over the next -20-30 years but does not reduce the need for a cervical screening programme for at least that time.

Coverage of HPV vaccination may be unequal and potentially widen health inequalities.

Identifying and treating people chronically infected with Hepatitis viruses in our communities is a major challenge.

Infections (5% of all cancers)

Public Health Challenges

Some Facts

Not a CRS current focus

others
UV light 1% (skin cancers)

Getting sunburnt in adolescence is a particular risk factor for malignant melanoma in adulthood which still has a fatality rate of 15%.

Maintain and support SunSmart campaigns

Ensure action with the sun tanning salon sector to support restricting tanning sessions to adults.

Holidays abroad to the sun still increasing – must maintain the messages

Melanoma is one of the two cancers that are commoner in people from less disadvantaged areas.

Others

Public Health Challenges

Some Facts

others11
Ionising radiation (5%)

Radon

Medical exposure

Occupational 2% (6% or 10,000 cancers a year in men)

Pollution 2% (lung cancer)

Healthy workplaces

HSE and exposure to dangerous chemicals and substances (particularly dyes, oil/petrol products, metal and furniture industries and asbestos)

Often long periods of historical exposure before the cancer presents (eg asbestos)

Others

Public Health Challenges

Some Facts

Not a CRS current focus

genetic testing
Genetic inheritance 1%

About 1% of cancers are directly inherited from a single high risk gene which makes the risk of children getting a similar cancer very high indeed (30-50% or more)

Ensure quality services in all areas

Public awareness

Skilled training to ensure sensitive approaches

Significant stigma, denial or fear may limit access

Genetic testing

Public Health Challenges

Some Facts

raising awareness of the importance of prevention
Raising awareness of the importance of prevention
  • Individuals and communities at risk need
      • support in awareness of the importance of long term prevention
      • Available and accessible preventative services
  • Need to link with Healthier Communities Collaboratives around symptom recognition
  • Need to understand who and how to target better
  • Raise awareness amongst commissioners to ensure the delivery of prevention is achieved equitably.
using information
Awaiting national tools, survey data and network on awareness gaps

Can use existing knowledge:

MOSAIC groups each have a different rate/index of cancer

Major responsibility to ensure we reduce health inequality

Using information

Nottingham: Mosaic Group F: ‘people living in social housing with uncertain employment in deprived areas’

summary
Summary
  • Smoking remains the most important issue
  • Key challenges nationally on several causes of cancer (alcohol and obesity)
  • Cancer Reform Strategy key but additional preventative activity underway and important
  • Need to link national work on understanding communities attitudes to causes and prevention: most causative factors that can be influenced are common to heart disease and diabetes agendas too.
  • Cancer prevention is a long term business – 10 to 30 years lag, and often intergenerational, so must plan for the long term.
  • We should strive to annually increase the proportion of cancer funding that we spend on prevention