Avoidable Lifestyle factors implicated in 2,500 cancer cases a week that could be prevented

More than 2,500 cancer cases a week could be avoided | Cancer Research UK  |  March 2018 

Cancer Research UK has published findings which demonstrate that almost 4 in 10 ( 37.7 per cent) of cancers could have been prevented. The landmark study highlights that many lifestyle factors could contribute to an individual’s risk of developing cancer.  The study identifies 135, 500 cases of cancer a year in the UK that could be prevented through lifestyle changes. The research findings have been published this month in the British Journal of Cancer  (the full abstract at the end of the post).

cancer research
Image source: cancerresearchuk.org

While smoking was to blame for the largest percentage of preventable cancer cases, using data from 2015 the researchers observed,  tobacco smoke caused around 32,200 cases of cancer in men (17.7% of all male cancer cases) and around 22,000 (12.4%) in women.

Obesity is the second highest contributory risk to developing cancer: around 22,800 (6.3%) cases of cancer a year are down to being overweight or obese. This is equivalent to around 13,200 (7.5%) cases of cancer in women and around 9,600 (5.2%) in men. The results imply that 5% (1 in 20) cancer cases might possibly be prevented by maintaining a health weight. Obesity has been linked to 13 different types of cancer, such as cancers of the bowel, breast and kidney.

The third greatest factor in preventable cancers was overexposure to UV radiation from the sun and sunbeds, associated with around 13,600 cases of melanoma skin cancer a year, 3.8% of all cancer cases.

Other preventable lifestyle risks outlined in the study were eating too little fibre causing around 11,900 cases equivalent to 3.3% each, drinking too much alcohol (attributed to causing 11,700 cases or 3.3% each.

In repsonse to the findings of the research, Sir Harpal Kumar, Cancer Research UK’s chief executive, said: “Leading a healthy life doesn’t guarantee that a person won’t get cancer, but it can stack the odds in your favour. These figures show that we each can take positive steps to help reduce our individual risk of the disease.” (Cancer Research UK)

Full press release from Cancer Research UK here 

Full reference: Brown, K. F., et al   | 2018 |  The fraction of cancer attributable to modifiable risk factors in England, Wales, Scotland, Northern Ireland, and the United Kingdom in 2015  |British Journal of Cancer | doi:10.1038/s41416-018-0029-6

Abstract

Background

Changing population-level exposure to modifiable risk factors is a key driver of changing cancer incidence. Understanding these changes is therefore vital when prioritising risk-reduction policies, in order to have the biggest impact on reducing cancer incidence. UK figures on the number of risk factor-attributable cancers are updated here to reflect changing behaviour as assessed in representative national surveys, and new epidemiological evidence. Figures are also presented by UK constituent country because prevalence of risk factor exposure varies between them.

Methods

Population attributable fractions (PAFs) were calculated for combinations of risk factor and cancer type with sufficient/convincing evidence of a causal association. Relative risks (RRs) were drawn from meta-analyses of cohort studies where possible. Prevalence of exposure to risk factors was obtained from nationally representative population surveys. Cancer incidence data for 2015 were sourced from national data releases and, where needed, personal communications. PAF calculations were stratified by age, sex and risk factor exposure level and then combined to create summary PAFs by cancer type, sex and country.

Results

Nearly four in ten (37.7%) cancer cases in 2015 in the UK were attributable to known risk factors. The proportion was around two percentage points higher in UK males (38.6%) than in UK females (36.8%). Comparing UK countries, the attributable proportion was highest in Scotland (41.5% for persons) and lowest in England (37.3% for persons). Tobacco smoking contributed by far the largest proportion of attributable cancer cases, followed by overweight/obesity, accounting for 15.1% and 6.3%, respectively, of all cases in the UK in 2015. For 10 cancer types, including two of the five most common cancer types in the UK (lung cancer and melanoma skin cancer), more than 70% of UK cancer cases were attributable to known risk factors.

Conclusion

Tobacco and overweight/obesity remain the top contributors of attributable cancer cases. Tobacco smoking has the highest PAF because it greatly increases cancer risk and has a large number of cancer types associated with it. Overweight/obesity has the second-highest PAF because it affects a high proportion of the UK population and is also linked with many cancer types. Public health policy may seek to mitigate the level of harm associated with exposure or reduce exposure levels—both approaches may effectively impact cancer incidence. Differences in PAFs between countries and sexes are primarily due to varying prevalence of exposure to risk factors and varying proportions of specific cancer types. This variation in turn is affected by socio-demographic differences which drive differences in exposure to theoretically avoidable ‘lifestyle’ factors. PAFs at UK country level have not been available previously and they should be used by policymakers in devolved nations. PAFs are estimates based on the best available data, limitations in those data would generally bias toward underestimation of PAFs. Regular collection of risk factor exposure prevalence data which corresponds with epidemiological evidence is vital for analyses like this and should remain a priority for the UK Government and devolved Administrations.

 

Advertisements

Understanding GP attitudes to cancer preventing drugs

A study by Cancer Research UK concludes that GPs want more support when offering drugs that lower the risk of certain cancers. It finds that GPs are more comfortable to discuss drugs, and more willing to prescribe or recommend drugs when they are supported by secondary care clinicians. Cancer Research UK

medicine-385947_1920

Understanding GP attitudes to cancer preventing drugs is aimed at increasing understanding GP attitudes towards offering the use of tamoxifen and aspirin to lower the risk of cancer, or prevent cancer. This is an area where there is little research around clinician attitudes and knowledge.

The study surveyed 1,007 GPs from across the UK. It found nearly half of GPs were unaware of the potential benefits of tamoxifen to prevent breast cancer among women with a clear family history of the disease who are therefore at higher risk.

The study also showed that more needs to be done to promote the evidence and guidance on chemoprevention. The research suggests that ensuring evidence based chemoprevention is routinely discussed with and offered to the people who may benefit should be a priority across the UK.

Executive summary: Understanding GP Attitudes to Cancer Preventing Drugs 

Full report: Understanding GP Attitudes to Cancer Preventing Drugs

NICE: Women with family history of breast cancer should take pill

Hundreds of thousands of healthy women should take pills to cut their risk of breast cancer, says NHS watchdog NICE | BBC News

drug-1674890_960_720.png

The draft guidelines for England say women predisposed to breast cancer because of a strong family history of the disease need this protection.

There are now three drugs to choose from – tamoxifen, raloxifene and, for the first time, anastrozole. Anastrozole is cheaper than the other two and, for some women, has fewer side-effects and is more effective.

Read the full news story here

Read the NICE draft guidelines here

Sun protection for preventing basal cell and squamous cell skin cancers

Sanchez, G. et al. Cochrane Skin Group. Published online:  25 September 2016

clouds-429228_960_720

Keratinocyte cancer (BCC and cSCC of the skin) is the most commonly identified type of skin cancer. The main risk is exposure to ultraviolet radiation, which is a component of sunlight. Prevention has become an important way to manage this cancer, so it is important to assess the effectiveness of methods used to prevent keratinocyte cancer in the general population. In this review, we assessed the effects of using topical sunscreen and physical barrier methods (such as sun-protective clothing, hats, sunglasses, and the active search for shade when outdoors) compared with no specific precautionary interventions aimed at preventing the development of BCC and cSCC in adults and children.

We searched the medical literature up to May 2016 for randomised controlled trials that evaluated preventive strategies. We found only one study suitable for inclusion. This study compared the daily application of sunscreen (with or without beta-carotene, which is a precursor of vitamin A) compared with the occasional use of sunscreen (with or without beta-carotene) in the general population, without restriction by gender or age. The study was undertaken in Australia, where 1621 participants, 55% of them with fair skin, were monitored for 4.5 years for new cases of BCC or cSCC assessed by histopathology (which is a method used to detect cancerous cells under the microscope).

We found no difference between the number of people who developed BCC or cSCC in the two groups over the time period of the trial. So, there did not seem to be a difference in applying sunscreen daily compared with using it occasionally.

Read the full review here

Delivering world class cancer services

NHS pushes forward with ambition to create world class cancer services

The NHS in England has set out its plans to deliver world class cancer services, which includes a fund to find new ways of speeding up diagnosis with the potential to save thousands more lives every year.

fiveyrforward
image source: http://www.england.nhs.uk

The National Cancer Transformation Board has published a wide ranging plan designed to increase prevention, speed up diagnosis, improve the experience of patients and help people living with and beyond cancer.

This follows the release last year of the report of the NHS’s Independent Cancer Taskforce  which identified how the NHS can achieve world-class cancer outcomes and save 30,000 lives a year by 2020.

Read more from NHS England here

Precision prevention of colorectal cancer

Fred Hutchinson Cancer Research Center. ScienceDaily. Published online: 18 April 2016.

In work presented at the American Association for Cancer Research’s annual meeting in New Orleans, Hsu and other researchers from Fred Hutch, the University of Michigan and other research groups debuted their latest progress in precision prevention — an in-the-works method to predict risk of colorectal cancer that integrates genetic, lifestyle and environmental risk factors.

This research is not yet ready to move into clinical practice, said Fred Hutch epidemiologist Dr. Ulrike “Riki” Peters, one of the study authors. But it’s the first attempt at combining so many different areas of colorectal cancer risk into one convenient risk predictor.

Read the commentary here

Cancer expert says public health, prevention measures are key to defeating cancer

ScienceDaily March 3, 2016

Is investment in research to develop new treatments the best approach to controlling cancer? Would emphasizing prevention bring about more return on investment? Should we channel what we are learning about precision medicine and the genome into cancer prevention, not treatment alone?

Many people believe that the time is right for another big push to defeat cancer, including President Obama, who called for a major cancer-fighting campaign in his final State of the Union address. But in the latest paper, “Targeting the Cancer Moonshot” in JAMA Oncology, this kind of effort will never cure cancer without public health and prevention.

While there have been some important and notable cures for certain types of cancer in the last half-century, Alfred I. Neugut, MD, PhD, Myron M. Studner Professor of Cancer Research and professor of Epidemiology at Columbia University’s Mailman School of Public Health, and co-author Cary P. Gross, MD, Yale University School of Medicine, drive home the point that these cures are responsible for only a small fraction of improvements in mortality.

Read the full commentary here