Early de­tec­tion of cancer is key to sur­vival

Ahead of Irish Cancer Week, we look at the role of three gen­eral cat­e­gories – genes, age and life­style – in the di­ag­no­sis of cancer

The Irish Times - Tuesday - Health - - Health l Cancer - Ar­lene Har­ris can­cer­week.ie; cancer.ie; mariekeat­ing.ie for more in­for­ma­tion Ini­ti­ated by the Irish Cancer So­ci­ety and Trin­ity Col­lege Dublin, Cancer Week Ire­land is in­tended to start a na­tional con­ver­sa­tion about cancer. The week runs from Mon­day, Sept

Ev­ery­one knows some­one who has been af­fected by cancer – whether as a pa­tient or a carer. And as lat­est statis­tics show that one in three of us may de­velop some form of cancer dur­ing our life­time, it is be­com­ing in­creas­ingly im­por­tant that we ed­u­cate our­selves about the risks and the ways we can pre­vent it.

Dr Robert O’Con­nor, head of re­search at the Irish Cancer So­ci­ety, says life­style has a big im­pact on cancer risk and gen­der can also play a role. For ex­am­ple, while fig­ures for lung cancer among men are drop­ping, the num­bers among women are not re­duc­ing at the same rate be­cause “at the end of the last cen­tury women did not give up smok­ing with the same fre­quency as men”, he says.

“While there are many dif­fer­ent con­tri­bu­tions to the rel­a­tive risk of be­ing di­ag­nosed with cancer, they can be bro­ken down into three gen­eral things: genes, age and life­style,” says O’Con­nor.

“Ge­netic risks are much the same as they have been for gen­er­a­tions. How­ever, as our pop­u­la­tion ages, more peo­ple will de­velop cancer. At the turn of the 1900s, the av­er­age per­son could ex­pect to live to 40-45 years of age. To­day, that fig­ure is more like 80, with women on av­er­age liv­ing two to three years longer than men. And with ad­vances in treat­ment for other dis­eases – par­tic­u­larly in­fec­tions and dis­eases of the cir­cu­la­tion – we are see­ing more dis­eases such as de­men­tias and can­cers.

“Other ma­jor fac­tors in­clude smok­ing, sun ex­po­sure, al­co­hol, ex­cess calo­rie in­take, and lack of ex­er­cise. The last three have a sig­nif­i­cant im­pact on fe­male can­cers, in­clud­ing breast and en­dome­trial, be­cause some women overindulge reg­u­larly with ex­ces­sive al­co­hol con­sump­tion, don’t man­age their weight and take too lit­tle ex­er­cise – so we are start­ing to see this im­pact a rise in the rates of these can­cers.”

“We are in the midst of a grow­ing cancer epi­demic,” says Dr O’Con­nor. “Around 24,000 of the peo­ple who are di­ag­nosed this year will have a se­ri­ous in­va­sive cancer ne­ces­si­tat­ing sig­nif­i­cant treat­ment, an av­er­age of 150 new cases will be di­ag­nosed ev­ery work­ing day, and ap­prox­i­mately 8,700 will die – which equates to a mem­ber of our com­mu­nity dy­ing of cancer ev­ery hour.

“Age is the big­gest risk fac­tor and, while there is noth­ing we can do about ad­vanc­ing age, four out of 10 can­cers could be pre­vented by sim­ple life­style mea­sures, es­pe­cially when in­tro­duced to chil­dren.”

The on­col­ogy ex­pert says while your where­abouts in the State does not have a huge im­pact on your risk of de­vel­op­ing cancer, your lo­ca­tion can be a fac­tor.

“Ge­og­ra­phy it­self has a small in­flu­ence, but if you live in an ur­ban area you are a bit more likely to get some can­cers,” he says. “How­ever, far and away the big­gest in­flu­ence is eco­nomics, so if you are from a poorer back­ground you are much more likely to get and die from sev­eral can­cers. The fig­ures are stark and a damming in­dict­ment of the com­pla­cency that has crept into all of Irish So­ci­ety.

“One of the fig­ures we reg­u­larly cite is that if you live in Mul­hud­dart you are nearly three times as likely to die from cancer than if you live in Castle­knock, which is right next door. The fac­tors un­der­ly­ing this are com­plex and there are no easy so­lu­tions but we know that ed­u­ca­tional at­tain­ment is the big­gest sin­gle de­ter­mi­nant of life­span across much of the world, in­clud­ing Ire­land.”

Most com­mon can­cers

The Na­tional Cancer Reg­istry, NCRI, is the source for all data re­lat­ing to cancer rates and lat­est fig­ures (from 2014) show the fol­low­ing find­ings:

● In 2013 there were 37,000 cases of cancer (in­va­sive and non-in­va­sive).

● The num­bers are go­ing up by about 2-3,000 each year. This means in 2014 there were about 39,000; in 2015 that will likely have been 41,000; in 2016 – 43,000; and in 2017 – 45,000.

● Non-melanoma skin cancer is the most com­mon cancer (ac­counts for about one in three of all can­cers each year). These can­cers are usu­ally picked up early and not usu­ally fa­tal (al­though they can be). Melanoma is more wor­ri­some. It is es­ti­mated that at least 90 per cent of all skin can­cers are caused by over ex­po­sure to sun­light.

● Prostate (men only) and breast (al­most all fe­male) make up a 10th of the rest each.

● The next most com­mon is bowel cancer. Much of bowel is im­pacted by diet and ex­er­cise and screen­ing would both pre­vent bowel cancer oc­cur­ring by catch­ing it in an early, pre­can­cer­ous state.

● One out of 14 cases of cancer is lung cancer, the ma­jor­ity of which is smok­ing and tobacco-re­lated (pri­mary or se­condary smok­ing) plus some rem­nant in­dus­trial ex­po­sure. Lung is the big­gest cancer killers for both gen­ders, fol­lowed by bowel, then breast, prostate and pan­creas.

Who is at risk?

“Ev­ery­one is born with a risk of cancer,” says Dr O’Con­nor. “Some have a greater risk due to in­her­ited mu­ta­tions but en­vi­ron­ment and life­style are very big de­ter­mi­nants too.

“Broadly speak­ing about six out of 10 can­cers oc­cur due to rea­sons that are out­side con­trol – ge­net­ics make up about one in 10, while roughly four out of ev­ery 10 cases that present are due to poor life­style fac­tors and hence could tech­ni­cally be pre­vented.

“The key to min­imis­ing risk is ac­tu­ally rea­son­ably straight­for­ward, ex­cept peo­ple don’t feel em­pow­ered to take con­trol over cancer. But the num­bers are pre­dicted to dou­ble by about 2040 and many of us fear this is an un­der­es­ti­mate as it is mostly based on es­ti­mates of pop­u­la­tion age and does not take ac­count of cer­tain life­style fac­tors, such as obe­sity, the im­pact of which on cancer won’t be ev­i­dent for a few decades yet.”

Re­duc­ing the risk

Ac­cord­ing to the Irish Cancer So­ci­ety, re­duc­ing the risk of cancer is some­thing which all of us can ac­tively work on by fol­low­ing a few sim­ple steps:

1. Pre­ven­tion: adopt a healthy life­style from an early age – eat well, ex­er­cise, don’t smoke or use drugs and limit al­co­hol in­take.

2. Early de­tec­tion: Many can­cers are read­ily cured if caught early – for ex­am­ple 19 out of 20 bowel can­cers which are caught in stage one are cured and one in 10 peo­ple found with stage four bowel cancer will be alive five years later. But many peo­ple still ig­nore symp­toms and many fail to make use of free cancer screens

3. Treat­ment: En­gag­ing with ev­i­dence-based treat­ment and hav­ing ac­cess in a timely man­ner to the lat­est di­ag­nos­tics and medicines and hav­ing a skilled in­te­grated med­i­cal sys­tem prop­erly re­sourced to de­liver them has clear im­pact on out­come.

4. Post-treat­ment sur­vival fig­ures: Can­cers and var­i­ous treat­ments can raise the risks of sev­eral other fa­tal con­di­tions (such as car­dio­vas­cu­lar dis­ease). Hence main­tain­ing a healthy weight and ac­tively ex­er­cis­ing af­ter treat­ment ap­pear now to have big im­pacts on cancer re­cur­rence and the like­li­hood of death from cancer and other causes. There­fore act­ing on this knowl­edge would sig­nif­i­cantly im­prove out­come

‘‘ Age is the big­gest risk fac­tor and, while there is noth­ing we can do about ad­vanc­ing age, four out of 10 can­cers could be pre­vented by sim­ple life­style mea­sures

as well as the other ar­eas. There is no sin­gle fix and each as­pect has im­pact to a vary­ing ex­tent on dif­fer­ent can­cers.

He­len For­ristal, di­rec­tor of nurs­ing ser­vices at the Marie Keat­ing Foun­da­tion, echoes this ad­vice and also en­cour­ages peo­ple to self-ex­am­ine rou­tinely, stay safe in the sun and try to choose healthy op­tions wher­ever pos­si­ble.

“Think about ways you can cut back on sug­ary, fatty and pro­cessed foods and also in­te­grate more fruit and vegeta­bles into your diet,” she advises. “This can help im­prove your nu­tri­tion and help you lose weight. If you drink al­co­hol, try to drink less and have days on which you don’t drink any.

“It’s also vi­tal that we get more ac­tive. So, in­stead of meet­ing a friend for a cof­fee, meet for a walk, or, as the long evenings set in, ask a friend to join you for an ex­er­cise class – try to get 30 min­utes of ex­er­cise a day.

“Skin cancer is the most com­mon cancer in Ire­land and rates are grow­ing faster than any other. Women are more likely to get it than men, pos­si­bly be­cause we are more likely to sit by the pool or beach on our hol­i­days, or ex­pose our skin in the quest for that elu­sive tan. But re­mem­ber that, be­sides caus­ing age­ing, UV rays also cause skin cancer, which can be fa­tal, so it’s im­por­tant to wear sun­screen all year round and cover your skin.

“Cancer can be scary, but it’s im­por­tant to re­mem­ber that early de­tec­tion saves lives. Get to know your body. Check your breasts ev­ery month; ex­am­ine your moles and freck­les reg­u­larly for changes in size, colour and shape. Speak to your GP straight away if you no­tice any changes which last for a few weeks and can’t be ex­plained. Cancer sur­vival rates have never been higher, so if you think there is some­thing wrong, get help.”

Sur­viv­ing cancer

Dr O’Con­nor says while sur­vival rates are get­ting higher, rates of cancer are also ris­ing, but there are plenty of ways in which peo­ple can seek ad­vice.

“Cancer rates are on the rise,” he says. “So we strongly urge any­one with any ques­tion, big or small, about cancer to con­tact us in the fol­low­ing ways:

1) our cancer nurse line: 1800 200 700. This is manned dur­ing work­ing hours by a team of ex­pe­ri­enced cancer nurses who can give ad­vice and sup­port any and all cancer-re­lated queries.

2) By vis­it­ing one of the 13 Daf­fodil Cen­tres around the coun­try, where we can pro­vide face-to-face sup­port.

3) Or con­tact us through so­cial me­dia and our web­site, where again a qual­i­fied and ex­pe­ri­enced cancer nurse is wait­ing to an­swer and help with any ques­tion about cancer.”

Cancer re­search

The ICS is fund­ing a num­ber of col­lab­o­ra­tive cancer re­search ini­tia­tives fo­cused specif­i­cally on per­son­alised cancer treat­ment. These strate­gic ini­tia­tives are go­ing be­yond the lab­o­ra­tory to ask new ques­tions and look for an­swers which will ul­ti­mately save more lives and lead to im­proved treat­ments. Cur­rent ini­tia­tives fo­cus on breast, prostate and blood can­cers and the po­ten­tial to de­velop tar­geted or tai­lor-made drugs and pre­ci­sion treat­ments to treat pa­tients with dif­fer­ent needs.

Breast-Pre­dict

Ev­ery year, 3,000 women in Ire­land are di­ag­nosed with breast cancer and 690 die from the dis­ease. In 2013 the ICS launched Breast-Pre­dict to bring clin­i­cians, sci­en­tists, nurses and statis­ti­cians to­gether to work col­lec­tively to fight breast cancer.

Blood Cancer Net­work Ire­land (BCNI)

Blood can­cers make up ap­prox­i­mately 10 per cent of all can­cers and are the fourth most com­mon cause of cancer-re­lated deaths in Ire­land. In 2015 the ICS joined with Sci­ence Foun­da­tion Ire­land to launch BCNI, a new na­tional clin­i­cal re­search net­work of­fer­ing early stage clin­i­cal tri­als to blood cancer pa­tients who will re­ceive ac­cess to the lat­est drugs and treat­ments to im­prove out­comes and qual­ity of life.

The Sci­ence Foun­da­tion of Ire­land and ICS are in­vest­ing ¤2.65 mil­lion in this na­tional clin­i­cal re­search net­work.

Prostate: iProspect and Ip­cor

Each year more than 3,300 men in Ire­land are di­ag­nosed with prostate cancer. In 2014, the Movem­ber Foun­da­tion to­gether with the ICS in­vested ¤750,000 and launched iProspect to de­velop per­son­alised ther­a­pies for prostate cancer pa­tients and Ip­cor look­ing at the out­comes for Irish men di­ag­nosed with prostate cancer.

The vi­sion is to iden­tify new biomark­ers in ad­vanced prostate cancer pa­tients to al­low doc­tors to make rapid de­ci­sions as to the best course of treat­ment for each pa­tient and to iden­tify new ways to make sure men have the best pos­si­ble out­come af­ter prostate cancer treat­ment.

‘‘ Cancer can be scary, but it’s im­por­tant to re­mem­ber that early de­tec­tion saves lives. Get to know your body. Check your breasts ev­ery month; ex­am­ine your moles and freck­les reg­u­larly for changes in size, colour and shape

While cancer ■ sur­vival rates are get­ting higher, in­ci­dences of cancer are also ris­ing

Cancer Week Ire­land runs from Mon­day, Septem­ber 25th to Sun­day, Oc­to­ber 1st

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