Public Health Bulletin Edition 1, 2004 - SA Health - SA.Gov.au

Reducing Cancer Risk Through
Primary Prevention
Cynthia Spurr
Chief Project Officer, Department of Health
Michele Herriot
Manager Health Promotion Programs,
Department of Health
Over the past 40 years, research has identified primary
prevention approaches that reduce the risk of people
developing many types of cancer. The evidence outlining
the relationship between risk factors and cancer outcome
has been summarized by the National Health Priority
Action Council in the draft National Service Improvement
Framework for Cancer, 1 as follows:
“Reduce smoking: Tobacco smoking causes the following
cancers: lung; oral; nasal cavity and paranasal sinuses;
naso-, oro- and hypopharynx; larynx; oesophagus;
pancreas; stomach; liver; kidney; urinary tract; cervical;
myeloid leukaemia, vulva, penis, bladder, renal parenchyma
and renal pelvis 2-4 . In 2001, 19.5% of Australians (3.07
million Australians) aged 14 years and older smoked daily.
Limit alcohol intake: Alcohol is a causal factor for cancer
of the mouth, pharynx, liver, larynx, oesophagus and
breast cancer in women 2,3 . The Australian Institute of
Health and Welfare (AIHW) has estimated that 12% of
breast cancer may be attributable to alcohol intake. In
2001, 9.9% of people consumed alcohol in a manner that
put them at risk of long-term harm, while 34.4% put
themselves at risk of short-term alcohol-related harm on
at least one drinking occasion 5 .
Increase protection of skin from the sun: Basal cell
carcinoma, squamous cell carcinoma and melanoma are
caused by sun exposure 6 . Sun protection will prevent
approximately 90% of skin cancers. In 1999, between
78-82% of Australian secondary students, aged 12-17
years reported being sunburnt last summer.
Improving diet mainly by increasing the intake of fruit
and vegetables: The expert panel of the World Cancer
Research Fund concluded that inappropriate diets cause
around one-third of all cancer deaths 7 . It recommended
dietary diversity to maximise the likelihood of more
balanced as well as more adequate diets, noting that
there was convincing evidence of dietary protection
against cancer of many sites. The evidence was strongest
and most consistent for diets high in fruits and vegetables.
In 1995 in Australia approximately 44% of males and
34% of females did not consume fruit in the 24 hours
preceding the National Nutrition Survey, and 20% of
males and 17% of females did not consume vegetables 8 .
27
Reduction in rates of overweight and obesity: There
is sufficient evidence for a cancer-preventive effect from
avoidance of weight gain for cancer of the colon, breast
(post-menopausal), endometrium, kidney (renal-cell) and
oesophagus (adenocarcinoma) 9 . For premenopausal breast
cancer, the available evidence suggests a lack of a cancerpreventive
effect. In 2001, an estimated 2.4 million
Australian adults were obese (16% of men and 17% of
women aged 18 years and over). A further 4.9 million
Australian adults were estimated to be overweight but
not obese (42% of men and 25% of women) 10 .
Increased physical activity: There is sufficient evidence
for a cancer-preventive effect of physical activity for cancer
of the colon and breast, limited evidence for a cancerpreventive
effect for cancers of the endometrium and
prostate, and for all other sites the evidence is inadequate 9 .
In 2000, 57% of Australian adults, aged 18-75 years,
were spending sufficient time (ie, at least 150 minutes
of walking, moderate and/or vigorous activity per week)
being physically active for health benefits 11 .
Increased rates of safe sex: Prevention of Human
Papilloma Virus (HPV) infection would prevent cervical
cancer 12 . However, there is inconsistent evidence about
whether condoms can reduce the risk of HPV infection 12 .
Meta-analyses suggest that there is little benefit 13;14 .
However, ongoing randomised trials suggest there may
be some benefit 15 .”
Prevention strategies to address the determinants of
health
It is evident from the above that for some cancers, there
is considerable knowledge about their causes. Given this
evidence, what preventive approaches should be adopted
at the population level to reduce cancer risks The
framework below recognises that the health of individuals
and populations is determined by many factors (e.g.
social, educational, economic, environmental, early years,
genetic, psychosocial factors, health behaviours and the
health system) that may act alone or in conjunction with
each other. It identifies a range of factors that determine
health outcomes and impact on cancer risk. In designing
effective preventive strategies effort needs to be directed
towards different population groups in a range of settings
and incorporating findings from life course research. The
Ottawa Charter for Health Promotion outlines a range of
strategies for effective interventions (see box). Adoption
of a comprehensive range of strategies is essential for
successful outcomes.