LIFESTYLE

Chai Cancer Care Together Magazine 2016
Cancer prevention,
society and you
Unless society takes some radical measures, 50% of us
will get cancer. Even for a ‘glass half full’ person, that’s
a sobering statistic. But it’s within our power to change
the odds, says Professor Peter Sasieni
Peter Sasieni is Professor
of Biostatistics and
Cancer Epidemiology
in the Wolfson Institute
of Preventive Medicine
at Queen Mary
University of London.
He is Director of the Cancer Research UK
funded Cancer Prevention Trials Unit,
and Vice Director of the Department of
Health’s Policy Research Unit in Cancer
Awareness, Screening and Early Diagnosis.
Professor Sasieni’s research encompasses
both cancer screening and prevention (with
particular interest in cervical cancer), as
well as the design and analysis of clinical
trials. He has contributed to more than 200
scientific publications and sits on a number
of advisory and grant award committees.
Theoretically, we could prevent
nearly two-thirds of all cancers. A
realistic challenge would be to prevent
one-third by 2035 – that would mean
over 100,000 fewer people getting
cancer each year in the UK.
Cancer prevention takes place at three
levels: society needs to change the
social and economic factors that affect
lifestyles; individuals need to adopt
healthy behaviours; and safe clinical
interventions need to be offered to
those at greatest risk. Many people
assume that we can only prevent
cancers that are linked to modifiable
behavioural and environmental factors,
but there is much that can be done
medically, even for those with a genetic
predisposition to cancer.
HELP FOR SMOKERS
Tobacco smoking is the most
important risk factor for cancer,
responsible for more than 60,000 UK
cancers each year (19.4% of all
cancers). It is not enough to simply tell
smokers they should stop. Society
needs to help prevent teenagers from
starting and to offer support to adults
to quit. Increased pricing (through
taxation) has been extremely effective
over the years in reducing
consumption. Banning advertising,
particularly those which are aimed
at children, is both morally right
and an effective measure. Outlawing
smoking in enclosed public spaces
and standardised tobacco packaging
legislation also play a role in changing
attitudes so that smoking is no longer
viewed as socially acceptable.
Tobacco control also means supporting
individuals who want to quit. There
have been great advances in both the
advice and psychological strategies
and the pharmacological options
(e.g. nicotine patches) offered by
stop-smoking services and these
significantly increase the likelihood of
quitting. Electronic or e-cigarettes offer
a revolutionary approach that may
have a dramatic impact on cancer risk.
Although controversial, e-cigarettes are
undoubtedly much safer than tobacco
smoking. Many smokers find it easier
to switch to vaping (e-cigarettes)
than quitting, and the introduction
of e-cigarettes has not led to more
children lighting up. E-cigarettes could
have a major role to play in preventing
many of the 60,000 cancers currently
caused by smoking.
HEALTHY – THE
DEFAULT CHOICE
Other behavioural factors
important in the prevention
of cancer include poor diet
(accounting for 9.4% of all cancers
in the UK); being overweight and
obesity (5.5%); alcohol (4.0%)
and lack of exercise (1.0%). As
with smoking, more needs to be
done, both by society to encourage
individuals to default to healthy
choices and by each person to
take responsibility for their own
behaviours. Schools can provide
children with healthy food and
make it difficult to buy unhealthy
options. Similarly, more should
be done in our communities to
consider what we eat and drink at
social occasions. The new sugar
tax to be introduced in the UK is
welcome, but it will only work if
there is a price differential between
taxed and un-taxed products.
“More needs to be
done to encourage
individuals to
default to healthy
choices”
In case you are wondering
what constitutes a healthy diet
(for cancer prevention), you
should have at least five portions
of vegetables and fruit each
day; avoid red and particularly
processed meat; eat plenty of
fibre; and reduce your salt intake.
If you don’t already exercise,
taking half an hour of moderate
exercise at least five times per
week could reduce your risk
of bowel cancer by 25%.
VACCINATION GAINS
Clinical interventions to prevent
cancer may either be offered to
the whole population or targeted
at particular high-risk groups.
The most successful population
intervention is the human
papillomavirus (HPV)
vaccination. HPV is an extremely
common infection that
occasionally causes cervical
cancer (and certain other cancers
too). Vaccination against the two
most important cancer-causing
strains of HPV is already offered
to 12- to13-year-old girls and a
new vaccine that prevents an
additional five strains of the virus
has been licensed. These safe,
effective, vaccines could almost
eliminate cancers of the cervix,
anus, and tonsils. It is unfortunate
that in some circles there is poor
uptake of the vaccine and this
could lead to avoidable cases of
cervical cancer in the future.
SIMPLE AND
SURGICAL OPTIONS
Aspirin could have a substantial
impact on preventing cancer.
Someone aged 50 could reduce
their risk of cancer by about 5%
by taking a mini-aspirin daily
for 15, years with minimal sideeffects.
Continuing after the age
of 65 might prevent up to 9%
of cancers, though it would be
associated with a greater risk of
serious side-effects. Other drugs
(e.g. tamoxifen and aromatase
inhibitors) reduce the risk of
breast cancer by 30-50%, but
are associated with side-effects
so are only recommended for
women at elevated risk.
Finally, surgery can be used
to prevent cancer in those at
extreme risk. Following the
experience of Angelina Jolie,
there is greater awareness of
the use of mastectomy (breast
removal) and oophorectomy
(ovary removal) in women
with genetic mutations (such as
BRCA1 and BRCA2 mutations
which are more common in
Ashkenazi women) for breast
and ovarian cancer. Major
surgery is also used in individuals
with a certain genetic condition
that puts them at extremely
high risk of bowel cancer. The
more common use of ‘surgery’
is to remove pre-cancers found
on either cervical or bowel
screening. In both cases this
can usually be done as an
out-patient procedure without
a general anaesthetic and is
extremely effective. Cervical
screening has been attributed
with preventing 80% of cervical
cancers in regular attendees and
the bowel scope screening could
have a similarly dramatic impact
on cancers in the lower part of
the bowel. ■
The next leap
forward: take
responsibility
• Eat healthily
and undertake
moderate
exercise several
times a week
• Try to maintain
a healthy weight
• If you smoke, try
vaping instead
• Encourage your
daughters to
get vaccinated
against HPV
• Take advantage
of bowel scope
and cervical
screening
• Seek professional
advice if you
have a strong
family history
of cancer
• Discuss taking
aspirin with
your GP
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Chai Cancer Care Together 2016 Chai Cancer Care