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Cancer Prevention: Evidence for Strategies that Can Reduce the Risk of Cancer

Hormone replacement, Men's Health, Weight loss, General, Women's Health | October 27, 2015 | Author: The Super Pharmacist

women, men, general

Cancer Prevention: Evidence for Strategies that Can Reduce the Risk of Cancer

Cancer is a diverse group of several hundred diseases in which some of the body’s cells become abnormal and begin to multiply out of control. The abnormal cells can invade and damage the tissue around them, and spread to other parts of the body, causing further damage and potentially death. Despite a decline in cancer deaths and an increase in survival over time, cancer is still the second-most common cause of death in Australia—after cardiovascular diseases. In 2011, there were 118,711 new cases of cancer diagnosed in Australia (67,117 males and 51,594 females). In 2015, it is estimated that 126,800 new cases of cancer will be diagnosed in Australia (69,790 males and 57,010 females). The most common cancers projected to be reported in Australia in 2015 are summarised in the table below.  

Table 1. Projected estimates of the most common cancers in Australia in 2015.1

Common cancersThe European Code against Cancer is an initiative of the European Commission to inform people about actions they can take for themselves or their families to reduce their risk of cancer. Conservatively, it is estimated that about one-third of cancers arising in the Australian population are attributable to modifiable causes and could – in theory – be prevented if exposure to those factors were eliminated entirely. Of those cancers that have known causes, about half are potentially preventable in men, and more than one-third are preventable in women. Extreme interventions would be required to eradicate all modifiable causes of cancer and such interventions are unlikely to ever be realised. However, substantial gains can be realised by targeting smoking, diet, alcohol and sun exposure.2 The most recent (fourth) edition of the European Code against Cancer, published in 2014, consists of 12 recommendations that most people can follow without any special skills or advice.3 The more recommendations people follow, the lower their risk of cancer will be. The Code is a preventive tool aimed at reducing the cancer burden by informing the public how to avoid or reduce carcinogenic exposures, adopt behaviours to reduce cancer risk, and to participate in organised intervention programmes. The Code was drawn up by the International Agency for Research on Cancer (IARC), the specialised cancer agency of the World Health Organization, with the participation of the European Commission.

 

What Is the Evidence that Supports the Recommendations of the European Code against Cancer?

Cancer Prevention: Evidence for Strategies that Can Reduce the Risk of CancerTobacco

Evidence on the causal association between smoking and cancer are convincingly documented for the haematopoietic system (specifically, myeloid leukaemia), for cancers of the cervix, colorectum, kidney, larynx, liver, lung, nasal cavity and paranasal sinus, oesophagus, oral cavity, ovary, pancreas, pharynx (naso-, oro-, and hypo-pharynx), stomach, ureter, and urinary bladder, and for liver cancer (in the children of smokers).4-6 Evidence on the causal association between smokeless tobacco overall and cancer was assessed as convincing for cancers of the oesophagus, oral cavity, and pancreas, from the IARC Monographs.4,6,7

Health body weight

Evidence on the causal association between excess body weight and cancer was assessed and updated as convincing for cancers of the breast (postmenopausal), colorectum, endometrium, gall bladder, kidney, oesophagus, ovary, pancreas and prostate (advanced).8-10

Be physically active every day

Evidence on the protective association between physical activity and cancer was assessed and updated as convincing for colorectal cancers and endometrial cancers.8, 9

Diet

A healthy diet is recommended which includes whole grains, vegetables, and fruit. High-calorie foods (foods high in sugar or fat) and sugary drinks should be limited. In addition, processed meat, red meat, and foods high in salt should be rescricted. Evidence on the protective association between dietary fibre and colorectal cancer was assessed and updated as convincing.9 Evidence that diets rich in high-calorie foods, such as fatty and sugary foods, and in sugary beverages lead to excess calorie intake and promote obesity, and in turn lead to an increased risk of cancer, was assessed as convincing. Evidence on the causal association between high intakes of red meat and processed meat and colorectal cancer was assessed and updated as convincing.9 Evidence on the association between salt intake and stomach cancer was strong enough to make the recommendation.8

alcohol dependenceAlcohol

Evidence on the causal association between alcohol and cancer was assessed as convincing for cancers of the colon, female breast, larynx, liver, oesophagus, oral cavity, pharynx, and rectum. 11-13

Sun exposure

Evidence on the causal association between exposure to UVR and cancer was assessed as convincing for all types of skin cancer.14 Evidence on the causal association between UVR-emitting devices (e.g. sunbeds) and skin cancer was assessed as convincing.

Cancer causing chemicals in the workplace

Evidence on the causal association between 44 chemical exposures in the workplace and cancer (including cancers of the larynx, liver, lung, nasopharynx, ovary, stomach, and urinary bladder, as well as non-melanoma skin cancer, leukaemia and lymphoma, mesothelioma, and sinonasal cancer) was assessed as convincing.15

Radon

Evidence on the causal association between radon and lung cancer was assessed as convincing.16

Breastfeeding

Evidence on the protective association between breastfeeding and breast cancer was assessed and updated as convincing.9, 17

Hormone replacement therapy

Hormone replacement therapy (HRT) is usually prescribed as a combination of oestrogen and another synthetic version of the female hormone, progesterone. It is used to address menopausal symptoms such as hot flashes, especially when they are causing sleep disturbance. Women who only have vaginal menopause symptoms such as vaginal dryness or itching and are not experiencing hot flashes should pick a vaginal form of oestrogen.4 Other safe and effective non-hormonal medications exist to address a woman's concerns regarding osteoporosis. The use of oestrogen therapy without synthetic progesterone (progestin) is associated with an increase in the risk of uterine cancer. The use of oestrogen-progestin combination HRT does not. Oestrogen-progestin HRT, however, has been linked to an increased risk of breast and ovarian cancer.15, 18, 19

Cancer Prevention: Evidence for Strategies that Can Reduce the Risk of CancerViruses, vaccination programmes, and treatment

The Code recommends that children be vaccinated for

  • Hepatitis B (for newborns)
  • Human papillomavirus (HPV) (for girls)

Human papilloma virus: A few types of human papilloma virus (HPV) are the main causes of cervical cancer, which is the second most common cancer among women worldwide. HPVs also have a role in causing some cancers of the penis, anus, vagina, and vulva. They are linked to some cancers of the mouth and throat, too. Again, although HPVs have been linked to these cancers, most people infected with HPV never develop these cancers.20 Vaccines are now available to help protect against infection from the main cancer-causing HPV types. These vaccines are approved for use in females from age 9 up to their mid-twenties. Epstein-Barr virus: Epstein-Barr virus (EBV) is a type of herpes virus. It is probably best known for causing infectious mononucleosis, often called “mono” or the “kissing disease.” EBV infection increases a person’s risk of getting nasopharyngeal cancer (cancer of the area in the back of the nose) and certain types of fast-growing lymphomas such as Burkitt’s lymphoma. It may also be linked to Hodgkin lymphoma and some cases of stomach cancer. Hepatitis virus: Hepatitis B virus and hepatitis C virus can cause the long-term (chronic) infections that increase a person’s chance of liver cancer. Of the 2 hepatitis viruses, infection with hepatitis B virus (HBV) is more likely to cause symptoms, such as a flu-like illness and jaundice (yellowing of the eyes and skin). Most adults recover completely from HBV infection within a few months. Only a very small portion of adults go on to have chronic HBV infections, but this risk is higher in young children. Most patients with hepatitis C are asymptomatic, but long term infection may cause liver failure, liver cancer, and death. Projections estimate that these complications will triple by 2020. Chronic hepatitis C infection is curable, and successful viral eradication reduces liver related complications. There is a vaccine to prevent HBV infection, and The Code recommends participation programmes against hepatitis B for newborns. There is no vaccine against hepatitis C virus.   

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REFERENCES:

    1. Australian Institute of Health and Welfare 2014. Cancer in Australia: an overview, 2014. Cancer series no. 78. Cat. no. CAN 75. Canberra: AIHW.
    2. Whiteman DC, Webb PM, Green AC, et al. Cancers in Australia in 2010 attributable to modifiable factors: summary and conclusions. Aust N Z J Public Health. 2015 Oct; 39(5):477-84.
    3. Minozzi S, Armaroli P, Espina C, et al. European Code against Cancer 4th Edition: Process of reviewing the scientific evidence and revising the recommendations. Cancer Epid. 2015; http://dx.doi.org/10.1016/j.canep.2015.08.014 Published online Oct 2014. Accessed 24 Oct 2015.
    4. Cogliano VJ, Baan R, Straif K, Grosse Y, Lauby-Secretan B, El, GF, et al. Preventable exposures associated with human cancers. J. Natl. Cancer Inst. 2011; 103:1827–1839.
    5. IARC. Tobacco smoke and involuntary smoking. 83. IARC press, Lyon, France; 2004.
    6. IARC. Personal habits and indoor combustions. A Review of Human Carcinogens. 100 E. IARC press, Lyon, France; 2012.
    7. IARC. Smokeless tobacco and some tobacco-specific N-nitrosamines. 89. IARC press, Lyon, France; 2007.
    8. World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. AICR, Washington DC; 2007.
    9. World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project findings & reports. Available at: http://www.wcrf.org/int/research-we-fund/continuous-update-project-findings-reports Accessed 25 Oct 2015.
    10. World Cancer Research Fund (WCRF) UK preventability estimates from the Continuous Update Project findings and reports. http://www.wcrf.org/cancer_statistics/preventability_estimates/index.php Published 2014. Accessed 25 Oct 2015.
    11. IARC Handbooks of Cancer Prevention. Vol 6: Weight Control and Physical Activity. (2002: Lyon, France).
    12. World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Report. Food, Nutrition, Physical Activity and the Prevention of Breast Cancer. 2008.
    13. World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Report. Food, Nutrition, Physical Activity and the Prevention of Colorectal Cancer. 2010.
    14. International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans; Vol. 100D. A Review of Human Carcinogens. Part D: Radiation/IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. WHO, Lyon, France; 2012
    15. Cogliano VJ, Baan R, Straif, K, Grosse Y, Lauby-Secretan, B., El, G.F. et al. Preventable exposures associated with human cancers. J. Natl. Cancer Inst. 2011; 103: 1827–1839.
    16. International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans; Vol. 100D. A Review of Human Carcinogens. Part D: Radiation/IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. WHO, Lyon, France; 2012.
    17. Norat T, Chan DS, Lau, R, Vieira, R, et al. The Associations between Food, Nutrition and Physical Activity and the Risk of Breast Cancer. 2008. Imperial College London Continuous Update Team Members.
    18. Menopausal hormone use and ovarian cancer risk: individual participant meta-analysis of 52 epidemiological studies. Collaborative Group on Epidemiological Studies of Ovarian Cancer. The Lancet. May 2015; 285 (9980): 1835 – 1842.
    19. IARC. Pharmaceuticals—A Review of Human Carcinogens. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. 100A. IARC, Lyon; 2012.
    20. Infections that lead to cancer. American Cancer Society. http://www.cancer.org/cancer/cancercauses/othercarcinogens/infectiousagents/infectiousagentsandcancer/infectious-agents-and-cancer-viruses Updated 24 Sept 2014. Accessed 25 Oct 2015.
    21. The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia. Annual surveillance report 2012. Sydney NSW: The Kirby Institute, the University of New South Wales, 2012.
    22. Gidding HF, Topp L, Middleton M, et al. The epidemiology of hepatitis C in Australia: notifications, treatment uptake and liver transplantations, 1997–2006.         J Gastroenterol Hepatol 2009; 24:1648–54.

 

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