Cancer and How to avoid it

QUB Staff wellbeing Initiative Dr Anna GavinDirector, N. Ireland Cancer RegistryQueen’s University Belfast29th January2014

Happy to answer questions

What is Cancer? and How does it start?

How many types?

Is cancer becoming more common?

Role of Screening for Cancer

What causes Cancer?

What can I do to avoid cancer?

Cancer - lot of different types

BrainHead & Neck

Gut Breast

BoneLeukaemia (Blood)

CervixKidney

ProstateLung

Skin

Common pathway - DNA in cells

Normal cells

Grow Limit growth Repair DNA damage

DNA damage

Genetics- tumour suppressor and activation genes- choose your parents well!

Growth unchecked◦Tumour

increasingly likely with age

Is Cancer More Common that 20/30/50 Years

Ago?

YES

-4% -2% 0% 2% 4% 6% 8%

Oral

Stomach

Colorectal

Lung

Melanoma

Breast

Cervix

Uterus

Ovary

Prostate

Decrease Annual percentage change (%) Increase

MaleFemale

MALES

Others28%

Trachea, Bronchus & Lung13%

Rectum4%

Stomach4%

Bladder3%

NHL3%

Kidney2%

Non-melanoma skin25%

Prostate11%Colon

7%

Lung24%

Stomach4%

Other25%

Leukaemia3%

NHL3%

Kidney3%

Bladder4%

Pancreas4%

Oesophagus6%

Colorectal11%

Prostate13%

Cancer deaths , males, UK, 2009Cancer incidence, males, Northern Ireland (1993-2011)

Ovary4%

Trachea, Bronchus & Lung 8%

Breast21%

Non-melanoma skin 26%

Others22%

Rectum3%

Colon7%

NHL3%

Uterus3%

Malignant Melanoma3%

Cancer incidence, females, Northern Ireland (1993-2011)

Colorectal10%

Ovary6%

Oesophagus3%

Stomach3%

Bladder2%

Leukaemia3%

NHL3%

Pancreas5%

Breast17%

Lung18%

Other29%

Cancer deaths, females, UK, 2009

Ageing population

Control of other diseases e.g. heart disease, infection

Better Diagnosis

Changing Risk Factors

Lung cancer ◦1912 - 12 deaths◦2012 – 1,127 cases

More openness regarding cancer

Ageing populationBetter diagnosisLifestyle - tobacco, diet, less exercise

More awareness of cases in community

Screening

0%

20%

40%

60%

80%

100%

0 1 2 3 4 5

Rela

tive

sur

viva

l (%

)

Years since diagnosis

Stage I

Stage II

Stage III

Stage IV

Unknown

1. Early Stage Disease – easier to treat and better survival – Goal REDUCE DEATHS

2. Some Screening Tests – pick up pre-cancer- Cervical Smear- Bowel Cancer Screening

3, Breast screening - picks up existing cancer

Figure: Relative survival of female breast cancer patients diagnosed in 1997-2006 (followed up to the end of 2011) by stage

DebateWhat are the harms and benefits of screening

0

20

40

60

80

100

120

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Euro

pean

age

-sta

ndar

dise

dra

te p

er 1

00,0

00 m

ales

Year of diagnosis/death

Incidence

Mortality

Breast 3 over diagnosed : 1 death prevented

Prostate 48 over diagnosed – 1 death prevented

Colorectal/Bowel and Cervix – pick up and treat early disease so preventing cancer

Estimated Percentage of Cancer Deaths Attributed to Various

FactorsOthers

14%

Industrial Products

1%

Pollution2%

Food Additives1%

Geophysical3%

Diet35%

Tobacco30%

Sexual/Reproduction

7%

Occupation4%

Alcohol3%

• Oral• Lung• Larynx• Stomach• Oesophageal• Pancreas• Cervix• Kidney• Bladder

Breast over age 50

Uterus

Kidney

bowel

Normal limits MEN <37” WOMEN <31.5”

Heart Disease Constipation Obesity Bowel Trouble Tooth Decay High Blood Pressure Diabetes Some Cancers Musculo-skeletal Problems

Use a smaller plate Expect results over a long period Eat smaller meals more often Change cooking method -

grill Don’t crash diet Increase exercise

No Risk

Avoid sunburn NO sunbeds Avoid 11am – 3pm Use shade Cover up – including hat and sunglasses Sunscreen – 15 Sun Protection Factor (SPF) Go early if concerned

Don’t Smoke

Eat 5 or more Fruit/Vegetables per day

Exercise

Avoid sunbeds and sunburn

Maintain sensible weight

Screening when invited – breast, cervix, bowel

Be aware of changes – cough, bowel, skin, weight

Seek medical advice early

Council &

Ste

erin

g

Gro

up P

HA

GAIN

Trusts

CRUK

QUB

BSO

HSCB

NISRA

Clin

ici

ans

ORECNI

DH

S

SPSNI

Pro

state

Cance

r U

K

Cancer

R&D

Focu

sM

acmillan

Office for Research Ethics CommitteesNorthern Ireland (ORECNI)

Thanks To:

Any questions?