Public Health and Cancer

Mortality Contributors in 2016 in the UK

  • Causes of death breakdown:

    • Cancers: 28%

    • Cardiovascular diseases: 26%

    • Other non-communicable diseases: 25%

    • Chronic respiratory diseases: 8%

    • Communicable, maternal, peri-natal, and nutritional conditions: 3%

    • Injuries: 1%

    • Diabetes: 8%

Leading Causes of Death in 2022

  • Overview of leading causes post dementia and Alzheimer’s:

    1. Ischaemic heart diseases: 59,356 deaths (10.3% of total, 4.2% increase from 2021)

    2. Chronic lower respiratory diseases: 29,815 deaths (5.2% of total, not a leading cause in 2021)

    3. Cerebrovascular diseases: 29,265 deaths (5.1% of total, 0.8% increase from 2021)

    4. Malignant neoplasm of the trachea, bronchus, and lung: 28,570 deaths (5.0% of total, 1.3% increase from 2021)

    5. COVID-19: 22,445 deaths (3.9% of total, 66.7% decrease from 2021)

Common Cancers

  • Statistics on cancer incidence from 2016-2018 in the UK:

    • Breast, prostate, lung, and bowel cancers together: 53% of all new cancer cases.

Bowel Cancer – The Facts

  • Incidence and mortality:

    • 40,000 people diagnosed annually.

    • 2nd largest cause of premature cancer deaths in the UK.

    • Affects men and women almost equally.

    • 95% of cases in individuals over 50.

    • Increasing rapidly in younger demographics.

    • Early diagnosis: 90% survival for over five years at earliest stages.

What is Bowel Cancer?

  • Definition and pathology:

    • Affects the large bowel (colon), rectum, and occasionally, the anus.

    • Also termed colorectal or colon cancer.

    • Can metastasize to the liver and lungs.

Progression of Bowel Cancer

  • Development:

    • Starts with polyps (wart-like growths) on the bowel wall.

    • Polyps become more common with age (1 in 10 people >60 have them).

    • Most polyps are non-cancerous; early detection allows painless removal via endoscopy.

Symptoms of Bowel Cancer

  • High-risk symptoms:

    • Persistent change in bowel habits (more frequent/looser for 3 weeks or more).

    • Bleeding from the anus without visible cause.

    • Severe abdominal pain.

    • Palpable right-sided abdominal mass.

    • Unexplained iron-deficiency anaemia.

    • Fast-track clinic referral within two weeks recommended.

  • Low-risk symptoms:

    • Rectal bleeding with anal symptoms.

    • Transient changes in bowel habits.

    • Non-severe abdominal pain (without higher risk signs).

    • Consider interactions of medications with symptoms.

Causes of Bowel Cancer

  • Genetic predisposition:

    • 5-10% of cases have a strong family history.

    • Inform GP if two close relatives have had bowel cancer.

  • Inflammatory bowel disease (IBD):

    • Long-term (>9 years) IBD or polyp formation increases risk.

  • Diet and lifestyle factors:

    • High intake of red/processed meats and low fiber/fruits/vegetables increases risk.

    • Sedentary lifestyle, excessive alcohol intake, tobacco use contribute to risk.

    • Obesity (BMI ≥ 40) strongly associated with bowel cancer incidence.

  • Unknown factors:

    • Strong correlations with Type II diabetes, Ashkenazi descent, chronic mental health issues.

Prevention of Bowel Cancer

  • Healthy dietary practices:

    • Varied diet with ≥5 servings of fruits and vegetables daily.

    • Prefer whole grain, beans, pulses, low-fat dairy, and white meat/fish.

    • Minimize animal fats, red meats, and preservatives.

  • Regular exercise and maintaining a healthy weight.

  • Smoking cessation and reduced alcohol consumption.

  • Awareness of bodily changes to recognize symptoms early.

Screening for Bowel Cancer

  • Objectives:

    • Detect cancer at early stages, more amenable to treatment.

    • Reduces death risk from bowel cancer by 16%.

    • Identifies benign polyps which can become cancerous.

  • Screening method:

    • Faecal immunochemical test (FIT kit) for hidden blood in stool.

  • Procedure:

    • Screening kit received by eligible individuals (ages 50-54) and subsequently every two years.

    • Instructions provided for stool sample collection; samples sent to a lab for processing.

    • Results in about two weeks.

    • This test indicates if further investigations are necessary.

Treatment of Bowel Cancer

  • Primary treatment: Surgery.

  • Advanced cases may require:

    • Chemotherapy and radiotherapy.

  • Post-treatment symptoms:

    • Low mood, depression, sleep disturbances, appetite changes common.

    • Potential issues with bowel habits and control, pain, changes in sensation in extremities due to treatment side effects.

Dispensing and Supply of Oral Chemotherapy in Primary Care

  • Service models:

    • Level One - Baseline Service:

    • Patient referred from secondary care; blood checked for suitability; prescribed correctly; dispensed by pharmacist.

    • Level Two - Specialised Service:

    • Prescription checks against national standards; verifying prescriber's authorization.

    • Level Three - Advanced Service:

    • Clinical assessments, checking lab results, counselling on medicine use, and monitoring for toxicities.

Lung Cancer – Facts

  • Main statistics:

    • Most common cancer death cause in the UK, accounting for over 1 in 5 cancer deaths.

    • 41,428 new cases annually; about 114 cases a day.

    • Most common cancer in men (age > 55) after bowel and prostate and the second most common in women after breast.

  • Age demographics:

    • Rare in people under 40, spikes significantly in ages 75-84.

    • Prognosis is typically poor, with survival rates < 10% for 5 years.

    • Early stage detection increases treatment success by 40 times.

Lung Cancer – Key Signs and Symptoms

  • Symptoms warranting immediate medical attention:

    • Persistent cough lasting >3 weeks.

    • Changes in long-standing cough.

    • Frequent chest infections.

    • Blood in phlegm.

    • Unexplained breathlessness or fatigue.

    • Persistent chest/shoulder pain and unexplained swelling of face/neck.

Risk Factors for Lung Cancer

  • Major contributing factors:

    • Smoking: 90% of lung cancer deaths linked to smoking; heavy smokers (20+ cigarettes/day) at 20 times greater risk.

    • Passive smoking: Increased risk by 24% for non-smokers living with smokers.

    • Age: Greater incidence in individuals over 50.

    • Pre-existing conditions: COPD and previous cancer history.

    • Environmental factors: Exposure to asbestos and certain chemicals contributes to risk.

Role of Pharmacist in Lung Cancer Awareness

  • Responsibilities include:

    • Smoking cessation advice and raising public awareness.

    • Screening for symptoms during dispensing sessions.

    • Facilitating early diagnosis for better treatment outcomes.

Lung Cancer Screening

  • Availability of lung health checks:

    • Currently in select regions, nationwide by 2029.

    • Target demographic: Ages 55-74 who are current/former smokers and registered with a GP.

    • Process includes questions followed by a referral for a CT scan if high risk is anticipated.

Ovarian Cancer – The Facts

  • Prevalence:

    • Sixth most common cancer among UK women after breast, bowel, lung, uterus, and melanoma.

    • 12 women die daily from ovarian cancer.

    • Majority diagnosed in post-menopausal women aged 50+.

    • Prognosis is poor with a 35% five-year survival rate.

Key Signs and Symptoms of Ovarian Cancer

  • Difficult to detect due to overlapping symptoms with other conditions.

    • Frequent abdominal bloating.

    • Early satiety and persistent abdominal/pelvic pain.

    • Symptom combinations should prompt a GP referral.

Additional Symptoms of Ovarian Cancer

  • Other potential indicators:

    • Urinary frequency/urgency.

    • Changes in bowel habits.

    • Severe fatigue and unexplained weight loss.

    • Symptoms mimic those of IBS, yet IBS rarely presents for the first time in women >50.

Risk Factors for Ovarian Cancer

  • Demographics:

    • Women over 50 at highest risk.

    • Increased cases in women without children.

    • Family history of cancers (ovarian, breast) connects to genetic factors.

    • Certain hormonal therapy users may have increased risk.

    • Association with endometriosis.

Role of Pharmacist in Ovarian Cancer

  • Responsibilities include:

    • Awareness and monitoring for symptoms.

    • Patient inquiries upon dispensing, identifying risks especially in over-50s.

    • Advocating for women’s health through early diagnosis and awareness.

Bladder Cancer

  • Most common symptom: Blood in urine.

  • Tobacco smoke is a significant risk factor.

  • Common in men, noted as 4th most common cancer.

Cervical Cancer

  • HPV Vaccination:

    • Offered to girls aged 12-13 as part of NHS program, protects against cervical cancer.

  • Cervical screening (smear test) for individuals aged 25-64; every 3 years between 25-49 and every 5 years after 50.

HPV Vaccine Information

  • Available for girls born after September 1991 and boys after September 2006.

  • Protects against several cancer types and genital warts; Gardasil 9 covers 9 types of HPV.

Breast Cancer Symptoms

  • Most prevalent cancer type in the UK.

  • Initial symptoms often include:

    • Lumps or areas of thick tissue.

    • Changes in breast size/shape, discharge from nipples, lumps/swelling in armpits, skin dimpling/rashes.

    • Mammograms from ages 50-71 every 3 years.

Genes and Breast Cancer (Hereditary)

  • BRCA1 and BRCA2 are tumor suppressor genes crucial for repairing damaged DNA.

  • Mutations significantly increase risks for breast and ovarian cancers.

  • Prevention strategies include prophylactic surgeries; 5-10% of cancers are hereditary.

Prostate Cancer

  • Incidence:

    • 1 in 8 men overall, 1 in 4 in black men.

    • Risk increases past age 50 with average diagnosis age 65-69.

    • Family history and obesity are significant risk factors.

Prostate Cancer Symptoms

  • Symptoms typically arise when cancer compresses the urethra, including:

    • Increased urination frequency, urgency, initiation difficulty, weak flow.

    • Symptoms of spread include pain in bones, testicles, and unexplained weight loss.

Prostate Cancer Screening

  • No national screening recommendations as PSA tests are unreliable.

  • 1 in 7 with prostate cancer may have normal PSA levels (false negatives).

  • Men >50 can discuss PSA testing with their GP.

Future for Pharmacy

  • Community pharmacy plans introduced 2019-2020 with a focus on prevention.

  • Proposal for early cancer diagnosis services to tackle health inequalities and increase early detection rates (from 50% to 75% stage 1 or 2 by 2028).

  • Trials for community pharmacy pilots to identify symptoms and refer directly for scans.

NHS CORE20

  • Aims to reduce healthcare inequalities, focusing on the most deprived 20% of the population identified by the Index of Multiple Deprivation.

  • CORE20PLUS5 highlights specific clinical areas to improve health access:

    • Maternity care for BAME communities.

    • Severe mental illness health checks.

    • Chronic respiratory disease management.

    • Early cancer diagnosis initiatives.

    • Hypertension case-finding and management.

    • Smoking cessation initiatives.

Test Yourself

  • Evaluate risk factors for different cancer types, including gastric cancer.

  • Review screening methods and appropriate ages for each cancer type.

References

  • Detailed citations from various health organizations and statistical reports on cancer.