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
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.”
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.”
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.
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