public health

PART 1: CANCER MORTALITY AND EPIDEMIOLOGY

Section 1: Mortality Contributors in the UK (Page 1)

1.1. Leading Causes of Death in 2022 (Page 2):

Following dementia and Alzheimer's disease, the remaining leading causes of death in England and Wales were:

• Key Takeaway: Lung cancer remains the most common cancer cause of death, accounting for 5.0% of all deaths in England and Wales in 2022.

Section 2: Common Cancers in the UK (Page 3)

• Breast, prostate, lung, and bowel cancers together accounted for over half (53%) of all new cancer cases in the UK in 2016-2018.

• The 3 most common cancers by gender and age (according to NHS Digital) vary by demographic group.

PART 2: BOWEL (COLORECTAL) CANCER

Section 3: Bowel Cancer – The Facts (Page 4)

Section 4: What is Bowel Cancer? (Pages 5-6)

4.1. Definition (Page 5):

• Bowel cancer is a disease of the:

  • Large bowel (colon)

  • Rectum

  • Rarely, the anus

• Also called colorectal or colon cancer.

• Advanced bowel cancer may spread to other parts of the body such as the liver or lungs.

4.2. Pathophysiology – Polyps (Page 6):

• It starts with wart-like growths, known as polyps, on the wall of the bowel.

• Polyps become increasingly common with age, but most will not become cancerous.

• Approximately 1 in 10 people aged over 60 have polyps.

• Clinical Significance: If polyps can be detected at an early stage, they can be removed painlessly by endoscopy, without the need for a major operation.

Section 5: Symptoms of Bowel Cancer (Pages 7-8)

5.1. Higher Risk Symptoms – Require Fast-Track Clinic Referral (Under 2 Weeks) (Page 7):

5.2. Lower Risk Symptoms – Can Be Treated and Watched by GP for Up to 3 Months (Page 8):

• Important Consideration: Consideration should also be given to potential short and longer-term side effects of OTC and prescribed medicines the patient may be taking, as these may be similar to, or mask, some of the presenting symptoms of bowel cancer.

Section 6: Causes of Bowel Cancer (Pages 9-10)

6.1. Family History (Page 9):

• Approximately 5-10% of diagnoses are made where there is a strong family history of the disease.

• GP should be informed if someone has two close relatives who have had bowel cancer.

6.2. Inflammatory Bowel Disease (IBD) (Page 9):

• People who have long-term (>9 years) IBD (e.g., Crohn's disease, ulcerative colitis) or those who have a tendency to develop polyps may have an increased risk.

6.3. Diet and Lifestyle (Page 10):

6.4. Other Associations (Page 10):

• Type II diabetes

• Ashkenazi blood lines (Jewish ancestry)

• People with learning difficulties or long-term mental health problems

Section 7: Prevention of Bowel Cancer (Page 11)

Section 8: Screening for Bowel Cancer (Page 12-13)

8.1. Aims of Screening (Page 12):

• Detect bowel cancer at an early stage, before symptoms appear, when treatment is more likely to be effective.

• Has been shown to reduce the risk of dying from bowel cancer by 16%.

• Can also detect bleeding polyps (pre-cancerous) which can be removed, reducing future cancer risk.

8.2. The FIT Kit (Faecal Immunochemical Test) (Page 12):

• Detects blood hidden in the faeces (stool) .

• Does not diagnose bowel cancer but indicates if further investigations are needed.

8.3. Eligibility and Process (Page 13):

Section 9: Treatment of Bowel Cancer (Page 14)

PART 3: LUNG CANCER

Section 10: Lung Cancer – Facts (Page 15-16)

10.1. Epidemiology (Page 15):

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

• New cases per year: ~41,428 (around 114 people per day).

• Position in men (>55): Third most common cancer (after bowel and prostate).

• Position in women (>55): Second most common cancer (after breast, followed by bowel).

10.2. Age Distribution and Prognosis (Page 16):

• Rarely diagnosed in people under 40; incidence rises steeply, peaking in those aged 75-84 years.

• Prognosis: Less than 10% survive for at least five years after diagnosis.

• However: When lung cancer is found at an early stage, treatment is 40 times more likely to be successful.

Section 11: Lung Cancer – Key Signs and Symptoms (Page 17)

Patients with any of the following symptoms should be advised to see their GP without delay:

Section 12: Who is at Risk of Lung Cancer? (Page 18-19)

12.1. Smoking (Page 18):

• Primary cause of lung cancer, accounting for approximately 90% of lung cancer deaths.

• Smokers smoking more than 20 cigarettes a day are 20 times more at risk.

• Women smokers are more likely to develop lung cancer compared to males who smoke (gender difference).

• Passive smoking: Non-smokers who lived with smokers are at a 24% increased risk.

• Cannabis: Smoking cannabis may also increase the risk.

12.2. Other Risk Factors (Page 19):

Section 13: Role of Pharmacist in Lung Cancer (Page 20)

• Smoking cessation advice (SCS advanced service from March 2022).

• Increasing public awareness of the signs and symptoms of lung cancer.

• Being alert to possible lung cancer symptoms.

• Asking questions when dispensing, responding to symptoms (e.g., cough – smoking cough changing in nature), or reviewing medicines.

• Effective treatment is more likely when cancer is found at an early stage.

Section 14: Lung Cancer Screening (Page 21)

• Availability: Currently only in some parts of England; will be available everywhere by 2029.

• Eligibility: Aged 55-74, registered with a GP, current or former smoker.

• Process: Appointment with questions; if anticipated high risk, referred for a CT scan.

PART 4: OVARIAN CANCER

Section 15: Ovarian Cancer – Facts (Page 22-23)

15.1. Epidemiology (Page 22):

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

• 12 women each day die of ovarian cancer.

• Around 80% of cases are diagnosed in post-menopausal women aged 50 and over.

• 5-year survival rate: 35% (poor prognosis).

15.2. Late Diagnosis (Page 23):

• Just 15% are diagnosed at stage one (cancer not spread beyond ovary).

• 75% are diagnosed at stage three and stage four (cancer spread outside the abdomen).

Section 16: Key Signs and Symptoms of Ovarian Cancer (Page 24-25)

16.1. The THREE Most Common Symptoms (Page 24):

• Action: A woman persistently experiencing one, or any combination, of the above symptoms should be referred to her GP.

16.2. Other Symptoms (Page 25):

• Urinary frequency or urgency

• Changes in bowel habit

• Extreme fatigue

• Unexplained weight loss

16.3. Important Clinical Note (Page 25):

• Ovarian cancer symptoms are very common and may suggest other conditions such as Irritable Bowel Syndrome (IBS) .

• However, IBS rarely presents for the first time in women aged over 50, the group most at risk of ovarian cancer.

Section 17: Who is at Risk of Ovarian Cancer? (Page 26-27)

17.1. Age and Reproductive Factors (Page 26):

17.2. Genetic and Other Factors (Page 27):

Section 18: Role of Pharmacist in Ovarian Cancer (Page 28)

• Being alert to possible ovarian cancer symptoms, especially in higher-risk patients.

• Asking questions when dispensing, responding to symptoms (e.g., IBS in over 50s), or reviewing medicines.

• Refer when needed.

• Increase awareness of ovarian cancer and its signs and symptoms.

• Effective treatment and longer survival are much more likely if women are diagnosed at an early stage.

PART 5: OTHER CANCERS

Section 19: Bladder Cancer (Page 29)

• Most common symptom: Blood in urine (haematuria).

• Common cause: Tobacco smoke.

• Demographics: Fourth most common cancer in men.

Section 20: Cervical Cancer and HPV Vaccination (Page 30)

20.1. HPV Vaccination:

• Offered to all girls aged 12-13 as part of the NHS childhood vaccination programme.

• Also offered to boys born after 1 September 2006.

• The vaccine protects against cervical cancer and other HPV-related cancers.

20.2. Gardasil 9 – Protects Against 9 Types of HPV:

20.3. Cervical Screening (Smear Test):

• Offered to all those with a cervix aged 25-64:

  • 25-49: Every 3 years

  • ≥50: Every 5 years

• A small sample of cells is taken from the cervix to be checked for HPV.

Section 21: Breast Cancer (Page 31-32)

21.1. Epidemiology (Page 31):

• Most common type of cancer in the UK.

• 8 out of 10 cases occur in women over 50, but younger women and, in rare cases, men can also get breast cancer.

21.2. Symptoms (Page 31):

• First noticeable symptom: Usually a lump or area of thickened breast tissue.

• Other symptoms:

  • Change in size or shape of one or both breasts

  • Nipple discharge (may be streaked with blood)

  • Lump or swelling in the armpits

  • Dimpling on the skin of the breasts

  • Rash on or around the nipple

  • Nipple changes (e.g., becoming sunken into the breast)

21.3. Screening (Page 31):

• Mammograms offered every 3 years from age 50-71.

21.4. Genetics and Breast Cancer (Page 32):

• BRCA1 and BRCA2 are tumour suppressor genes that produce proteins that help repair damaged DNA.

• Mutations in these genes prevent them from working normally.

• Risk:

  • About 5-10% of breast cancers and 10-15% of ovarian cancers are hereditary.

  • Mutations significantly increase the risk of breast and ovarian cancer.

• Preventive Options: Prophylactic (preventive) mastectomy or oophorectomy (removal of ovaries).

Section 22: Prostate Cancer (Page 33-34)

22.1. Epidemiology (Page 33):

• About 1 in 8 men (1 in 4 black men) will get prostate cancer in the UK.

• Risk increases with age; most common in men over 50; average age at diagnosis is 65-69 years.

• Risk increases with:

  • Family history of prostate or breast cancer (mainly BRCA2)

  • Overweight or obesity (increases risk of advanced cancer)

22.2. Symptoms (Page 34):

• Symptoms occur when the cancer has grown large enough to put pressure on the urethra:

  • Needing to urinate more frequently, especially at night (nocturia)

  • Needing to rush to the toilet

  • Difficulty starting to urinate

  • Straining or taking a long time to urinate

  • Weak flow

  • Feeling that the bladder has not emptied fully

• Advanced symptoms (spread): bone and back pain, loss of appetite, testicular pain, unexplained weight loss.

22.3. Screening (Page 35):

• No national screening programme for prostate cancer.

• PSA (Prostate-Specific Antigen) tests are unreliable:

  • False-positive: Around 1 in 7 men without prostate cancer have elevated PSA.

  • False-negative: Around 1 in 7 men with prostate cancer have normal PSA.

• Current Practice: Men aged 50 or over who decide to have their PSA levels tested after talking to a GP can arrange for it to be carried out free on the NHS.

PART 6: THE PHARMACY ROLE IN CANCER – SERVICES AND FUTURE DEVELOPMENTS

Section 23: Dispensing and Supply of Oral Chemotherapy in Primary Care (Pages 15-18 in original, summarised)

23.1. Three Levels of Service (Page 15):

Section 24: Future for Pharmacy (Page 37-38)

24.1. NHS Long Term Plan (Page 37):

• Committed to increasing the proportion of cancers caught early from half to three in four.

• New Community Pharmacy Contractual Framework (2019/2020) focuses on prevention.

• Exploring a service for early cancer diagnosis for tackling health inequalities.

24.2. Community Pharmacy Pilot (Page 38):

• From summer 2022: Community pharmacy pilot to refer patients with cancer symptoms.

• Customers with symptoms including:

  • Cough lasting three weeks or more

  • Difficulty swallowing

  • Blood in urine

• Will be referred directly for scans and checks without needing to see a GP if staff think it could be cancer.

PART 7: SUMMARY TABLE – CANCER SCREENING BY TYPE

SUMMARY TABLE: RISK FACTORS BY CANCER TYPE