Can you avoid cancer?

Peter Isaacs

Gastroenterology Unit

1 common cancers are not preventable

2 cancer only produces symptoms when its too late to treat

3 if its in your genes there’s nothing you can do

4 cancer treatment results are the worst in Europe

5 the nhs cannot provide the latest cancer drugs

cancer facts

“Cancer facts”

• WRONG on all counts

what is cancer?

• An abnormal population of cells which do not have the normal appearance of the originating organ ( loss of differentiation)

• These cells exhibit uncontrolled growth• The cells can invade locally or deposit in

distant organs producing displacement effects

How does cancer start?

• An ABNORMAL GENE(S) which make the DNA liable to further changes

• ENVIRONMENTAL challenges (chemicals, viruses or radiation) which push these changes

• PROLIFERATION of the cells under the stimulus of inflammation, hormones increase the likelihood of irreversible malignancy

How does cancer start?

Mutation of DNA (oncogene) which can be

• Congenital (eg familial colon cancer)• Acquired (carcinogens, radiation, ageing)

• more mutations if cell proliferation is high eg Barrett’s

• Inflammation• Hormonal eg breast, prostate• Viral infections eg HPV, HBV, HCV, HIV, EBV

Cancer etymology

• Latin the crab • Because of its sideways spread into the

healthy tissue

Carcinoma an epithelium or lining• Sarcoma in supporting tissues • Leukaemias, lymphomas, myeloma in bone

marrow and lymph nodes• Oncology = (Greek) tumour science

The CMO report 2009

Predicting who will get cancers

• FAMILY HISTORY • ALREADY HAD A CANCER• SMOKERS• DRINKERS• OBESE• MANUAL AND DIRTY INDUSTRIES• High UV and cosmic ray exposure• HIGH INCIDENCE AREA (e.g. radon,

selenium, industrial pollution Pb, As)• PHYSICALLY INACTIVE

Age and physical activity

• Declines by 9% every decade

how much of this is “cultural”

ACTIVITY: PREDICTED BENEFITS

• Coronary disease -10%• Stroke -20%• Diabetes II -40%• Colon cancer -45%• Breast cancer -30%• Hip fracture -50%

• 30 minutes of moderate activity 5X/week

Sir Liam Donaldson 2009 (Eng)

alc xs smoking obesity inactivity

Prevalence 7% 20% 24% 65%

Cost to UK £20BN 5.2 16 8

NHS COST 2.7 2.7 4.2 1.5

Blackpool annual health report 2008-9

• Population 142,500• Blackpool 12th of the 354 most deprived LAs• 41 of the 94 areas of Blackpool are in the

bottom 20% of England• Male life expectancy males is lowest in

England (73.2 yr) Blackpool nhs commits to• improve early detection of cancers• Better uptake national screen programmes• Better uptake of HPV vaccination

The Blackpool scene

• 40,000 drink alcohol excessively• 2,324 problematic drug users• 6,645 obese (BMI>30)

• Adults taking exercise 7.4% (Eng.10.8%)• Notifiable disease• Hepatitis B 22/year• Hepatitis C 106/year

Healthy government

• Minimum alcohol pricing Royal College of Physicians 2010

• Exercise for kids• Exercise for oldies Westminster Play park

Blackpool risks

• Alcohol, HCV and liver cancer• Obesity and oesophageal cancer• Cervix cancer• Lung cancer • Colon cancer

Colon cancer (office natl stats) 1971-2003

• Incidence increasing 43 to 55/100k/y• Mortality FALLING 30 to18/100k/y(M22,F14)

• 1 in 16 men , 1 in 20 women will develop colon cancer each year

• 5 yr survival rate has doubled in 30 years• (M 22% in 1970s, now 50%, F 23% now 51%)

MOH

National Bowel cancer screening

National Endoscopy Training Centre at The Mersey School of EndoscopyNational Endoscopy Training Centre at The Mersey School of Endoscopy

X

!

How to avoid cancer?

• Remember that about one third of the UK population will have some form of cancer in their lifetime, two thirds of these will not die of it

What foods to minimise?

• Red and processed meats• Saturated fats• Barbecues, fried, roasted and burnt• Very high chilli factor• Too hot too swallow• Pickles and high salt foods

Which foods to maximise?

• Fresh green leaf vegetables and carrots• Fresh fruits especially coloured• Olive oil, rapeseed oil, sunflower oil• Oily fish• Whole grain cereals

Daily life and cancer avoidance

• Don’t smoke at all (active or passive)• If your body’s function changes seek advice• Don’t drink alcohol daily• Screen skin especially children, but get out more• Become a vegetarian• Take daily exercise• Keep slim• Get appropriate vaccinations and ID treatments• Think about the nhs screening offers (cervix, breast,

colon)• Don’t worry be happy

CANCER PREVENTION

• CHOOSE PARENTS CAREFULLY• WALK TO THE VEGETABLE SHOP• FAVOUR THE FISHMONGER• WALK PAST THE PUB• RUN PAST THE TOBACCONIST• KEEP YOUR WEIGHT NEAR IDEAL• VOTE FOR HEALTH

Significant symptoms

• A new lump, change in a skin• Change in function of bowels or bladder,

appetite, weight, breathing, cough, swallow• Bleeding from anywhere• New pains which persist

Cancer research in Blackpool Fylde and Wyre

The nhs has increased and reorganised research funding

• Research networks support research in primary and secondary care

• Research nurses, support for doctors/AHPs• Research units established• Research governance

an emphasis on high quality large studies

Gastrointestinal cancer research in Blackpool

• Barretts oesophagus

ASPECT the value of acid lowering drugs in low and high dose in combination with aspirin n preventing oesophageal cancer

BOSS is surveillance endoscopy worthwhile?

Chemotherapy of oesophageal and gastric cancers

The future

• More longevity= more cancers• More research = more treatments and more

effective prevention• DNA profiling will make cancer risk

prediction more accurate • Targeted screening will focus resource on

those at risk• Surgery will become safer and even more

centralised

Cancer avoidance for HPs

• Assess risks Family history, occupation, habits, previous cancers, clinical pointers

• Give properly balanced evidence-based advice to our patients on whether to choose screening and surveillance

• Give unasked advice when behavioral risks are identified “ BRIEF INTERVENTION”

Cancer in the future….what can YOU do?

TAKE CARE OF YOUR OWN HEALTH ( Doctors are not very effective on cures)

Report significant symptoms earlyACT on correctable risks ( obesity, smoking,

alcohol excess, inactivity, poor diet, UV exposure)

Do you have a genetic risk and require screening?

Contribute to research ..participation in trials, surveys, support your local units research or cancer research UK