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

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Preventing Cancer current public health issues
and the Cancer Reform Strategy

• Dr Chris Packham

Cancer Research UK website
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What is the focus on prevention in the Cancer
Reform Strategy?

• Smoking
• Obesity
• Alcohol
• Excessive sunlight
• Infectious Disease
• Raising awareness about prevention
• Genetic services

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Causes of cancer 50 is preventable
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Smoking (30 all cancers)
Public Health Challenges
Some Facts

• 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

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Diet, Exercise and Obesity (25 of all cancers)
Public Health Challenges
Some Facts

• Red meat increase the risk of colon cancer by
  gt10
• 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

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Diet, Exercise and Obesity (25 of all cancers)
Public Health Challenges
Some Facts

• 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 gt25)
• 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

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Hormones (15 of all cancers)
Public Health Challenges
Some Facts

• 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.

Not a CRS current focus
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Alcohol (6 of all cancers)
Some Facts
Public Health Challenges

• 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.

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Infections (5 of all cancers)
Public Health Challenges
Some Facts

• 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.

Not a CRS current focus
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Others
Public Health Challenges
Some Facts

• 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.

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Others
Public Health Challenges
Some Facts

• 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)

Not a CRS current focus
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Genetic testing
Public Health Challenges
Some Facts

• 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

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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.
  

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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

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