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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?. Smoking Obesity Alcohol Excessive sunlight Infectious Disease

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

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  1. Preventing Cancer: current public health issues and the Cancer Reform Strategy Dr Chris Packham Cancer Research UK website

  2. What is the focus on prevention in the Cancer Reform Strategy? • Smoking • Obesity • Alcohol • Excessive sunlight • Infectious Disease • Raising awareness about prevention • Genetic services

  3. Causes of cancer: 50% is preventable

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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.

  14. 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’

  15. 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

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