One third of cancer deaths could be prevented by lifestyle changes alone. Population screening for cancer can detect precancerous lesions or early cancer when it is curable surgically.
Tobacco causes 20.1% of Australia’s cancer burden and nearly 21% of cancer deaths. It is responsible for 16 different cancers -- particularly lung, head and neck and bladder cancers. Just over 15% of Australians smoke daily, as do 47% Indigenous Australians. Price is the most effective tool for decreasing smoking when added to eliminating advertising (including on packs), mass media campaigns, smoke free work and public places and regulating supply. For those smokers who can’t quit “cold turkey”, nicotine replacement patches or gums are available.
Nutrition and physical activity
Appropriate nutrition and physical activity could prevent a quarter of cancers. Physical inactivity accounted for 5.6% of the total cancer burden, high body mass for 3.9% and low fruit and vegetable consumption for 2%.
Being overweight (BMI 25-30) or obese (BMI 30+) increases the risk of cancers of the oesophagus, pancreas, bowel, breast (post-menopausal), endometrium and kidney. One in four Australian adults is obese.
Physical activity independent of weight control has been shown to protect against bowel cancer and probably against post-menopausal breast cancer and endometrial cancer. Prolonged sedentary periods, irrespective of physical activity, increases the risk of bowel, endometrial, ovarian and prostate cancer. The World Cancer Research Fund dietary advice includes eating mainly fruit and vegetables and unprocessed cereals and pulses, and limiting the consumption of energy-dense food, sugary drinks, red meat (to 500 gm/wk), processed meats and salt. The usual recommendation for physical activity is at least 150 minutes over 5 sessions in a week, the more intense the better.
Up to 5.8% of cases of cancer in Australia have been attributed to the chronic use of alcohol. Starting at zero, the more consumed the greater the risk, irrespective of the type of drink. The NHMRC advises that alcohol consumption should not exceed 2 standard drinks each day. The related cancers include breast, mouth, pharynx and larynx, oesophagus, bowel and liver cancers. In head and neck and upper gastrointestinal cancers, tobacco has a synergistic effect.
Exposure to UV radiation is the major cause of skin cancer, with intermittent exposure linked more to melanoma and cumulative exposure to non-melanoma skin cancer. There are over 1800 deaths from skin cancer with around 1300 from melanoma. In Australia there are almost 12,000 cases of melanoma and estimations of over 400,000 non-melanoma squamous cell and basal cell skin cancers annually. Sun protection, by avoiding the sun when it is most intense in the middle of a summer day and covering up with hats, sunglasses and clothing supplemented by sunscreen (SPF 50+, broad spectrum and water resistant), is recommended when the UV index is 3 or above.
In 2006, it was estimated that 6.5% of cancer cases in Australia in 2005 could be attributed to workplace exposures (10.8% in men, 2.2% in women). Mesothelioma related to asbestos exposure is the best known. Other well established associations are between cadmium in electroplating and lung cancer, benzene and leukaemia and aromatic amine dyes and bladder cancer. The building industry has the highest occupation exposure, not only to silica and diesel exhaust but outdoor sun exposure. Relating occupational exposure to pesticides to cancer in particular occupations is difficult but studies show associations with lymphoma. Emerging concerns requiring research are manufacturing processes that involve nanoparticles.
Human papillomavirus (HPV) is necessary for the development of cervical cancer and there is a vaccination program for 12-13 year old boy and girls. Vaccinating against types 16 and 18 will reduce the incidence by 70%.
To prevent liver cancer, hepatitis B vaccination could be given to neonates or adults at high risk; such as IV drug users or those living in populations with a high incidence of hepatitis B infection.
There are 3 national screening programs for cancers of the cervix, breast and bowel. These are recommended because of the associated mortality reduction when weighed against overdiagnosis and its adverse effects.
Papanicolaou tests (Pap tests) for cancer of the cervix commencing with sexual activity and repeated every 2 years have halved the incidence of cancer of the cervix since their introduction in 1991.
Free screening mammography is encouraged for women from 50-74 years old and available for high-risk women from 40 years. There has been a 29% age-standardised decrease in breast cancer mortality compared to the decade before 1991, and we estimate at least half of that is due to screening.
The bowel cancer screening program was introduced in 2006 and aims to send faecal immunochemical testing kits to everyone from 50-74 years every 2 years by 2020, with the positives followed up by colonoscopy. Comparing screened with unscreened people there has been a halving in the presentation of stage 4 disease.
PSA testing is not recommended as a population screening test because a small survival gain is currently matched by widespread adverse effects stemming from overdiagnosis and overtreatment.
People are encouraged to get to know their skin lesions and promptly report any change rather than relying on formal annual skin checks. Likewise, promptly reporting symptoms and signs related to the testicles is recommended over regular screening examinations.
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