Author: Dr Claire Robertson, Senior Lecturer, School of Life Sciences

The Nuffield Trust recently explored reasons why, in the UK, we remain behind other countries when contrasting cancer outcomes and especially survival.  Considering lower survival statistics, presumably we should be more motivated to avoid developing cancer, yet Cancer Research UK estimate that every two minutes someone in the UK receives a diagnosis and incidence rates for all cancers combined have increased by more than a tenth since the early 1990’s (12%). It seems necessary for everyone in the UK to increase their awareness of our own, unique risk.  This requires us to consider our knowledge or perception of why and how each cancer-statistic impacts us, and therefore to consider how we might minimise risk and improve our own survival opportunities.  

It could be you… but you can try to avoid that

In one iconic podcast for “You, me and the big C,” Dame Deborah James described life with this illness as “the coolest club you never want to be a part of”.  Despite this, 1 in every 2 UK individuals will be diagnosed with cancer at some point in their lifetime.  These statistics need not apply to you however, since estimates suggest that four in ten cancer cases could be prevented by addressing overweight and obesity prevalence, increasing engagement with breastfeeding, and reducing alcohol intake for example (Brown et al., 2018).  Smoking is the single most preventable cause of cancer in the UK (accounting for approximately 15% of all cancers; ASH, 2017).  We know what we should be doing, the question is, why are we not following these recommendations and improving UK cancer statistics? 

Recommendations promoting health improvement and/or disease avoidance focus on ‘avoidance of disease’ perspectives.  If you smoke, Malarcher and colleagues (2000) suggest that you are 27 times more likely (than a non-smoker) to develop lung cancer.  But you might not.  Coupled with statistics presented by trusted bodies like the Centres for Disease Control and Prevention (CDC) who estimate that 10-20% of lung cancer patients impact individuals who never smoked or smoked fewer than 100 cigarettes in their lifetime, it’s easy to understand how and why we can hide behind an ‘it won’t happen to me…’ perception.  

Using the five W’s to evaluate your own risk

Irrespective of whether you consider cancer awareness from a professional perspective (e.g., as a health care professional or journalist) or more personally as the friend/ relative of someone recently diagnosed for example, you might be guided to consider risk using the five W’s: what, who, where, when and why, to ensure you consider the full story.  From the perspective of an epidemiologist (a scientists who studies the distribution and determinants of health-related states or events in specific populations, and applies related learning to how we control health problems), these ‘W’s’ consider what (understanding components linked to the diagnosis/ health event), who (considering the person or people impacted), where (specifics linked to the location or place you are interested in), when (the time period you are interested in), and why/ how (to understand causes, risk factors, and/ or modes of transmission considered important or of interest).  Such questions facilitate development of effective means to prevent and control diseases in populations – and to guide each of us, to determine how we can minimise our own risk.

Let’s start by considering what.  The UK currently has poor survival statistics linked to cancers when compared to other countries.  More than 80% of UK individuals with breast cancer survive the disease for at least 5 years post diagnosis for example.  That might not seem bad until comparisons with those observed elsewhere are considered.  In Cyprus for example, 90.6% reach this milestone.  In the United States and Brazil, 88.6% and 87.4% respectively survive at least five years post diagnosis (World Population Review, 2022).  Variance including that observed in incidence (new cases detected), treatment delays and linked to ‘unfavourable’ lifestyle choices may contribute to explain these statistics.  We can reflect on advice (e.g., consumption of a healthy Mediterranean diet and modest alcohol consumption, achieving a ‘favourable’ weight, increasing exercise, and reducing smoking and alcohol intake as means to explain these differences and promote personal health improvement strategies (OECD Country health profiles; WCRF cancer prevention recommendations), but it’s vital that each individual reflects on who, when and where when evaluating how reported statistics relate to them and their unique situation.  

As part of @WCRFInt Global Cancer Update Programme, our new major review of existing research, published today in @IntJCanc, has found certain key factors could impact the risk of death for women after a breast cancer diagnosis https://t.co/yX07j2Kglo @imperialcollege

— WCRF International (@wcrfint) October 25, 2022

We need to critique the information we are using to inform our own assessment of personal risk.  As we age for example, cancer risk elevates.  A typical proliferating human cell divides (on average) every 24 h, synchronizing with other physiological processes and our surrounding environment.  With each replication, errors can result and over time, mutations build up and can lead to cancer development.  Although we might instinctively seek to find the dissimilarities between what we read and how this relates to our own situation, ageing is not something we can avoid.  Improving the ‘environment’ within which our physiological processes occur can be achieved however – and the World Cancer Research Fund (WCRF) guidelines for preventing cancer offer lots of opportunities to start improving your health (and reducing your cancer risk).  

	Cyprus	UK
Incidence (cases/ 100,000)	60^	166~
# Physicians/ 1,000 people	2	5.8
Diagnosis to treatment	4 weeks (28 days)	*Goal: 85% within 62 daysAttainment: 61.8%

~Data for UK (Cancer Research UK) 

^Data for Cyprus (Hadjisavvas et al., 2010)

*Wishart, 2022

Small changes, starting today

Making healthy choices can be hard, and hurdles faced when planning to make positive choices impact some people more than others.  Start small, maintain and build on each small change: sign up to Dry January (if you missed Sober October), observe National No Smoking Day, or Walk all over Cancer committing to complete 10,000 steps each day for Cancer Research UK.  It’s never too late to start improving your health.