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By Ian N. Olver MD Biographical note
Introduction
Cancer is the leading cause of premature death in Australia. The mortality rate from cancer in 2005 was 234 per 100,000 men and 144 per 100,000 women. The leading cause of cancer death in men is lung cancer. In 2005, lung cancer overtook breast cancer to become the leading cause of cancer death in women.
One hundred years ago we could cure very few cancers; today, we can successfully treat over half of all cancers. The improvement is due to better treatments and earlier diagnosis. The survival rate for many common cancers has increased by more than 30 per cent in the past two decades.
Unfortunately, many people still die from cancers that could be prevented through a healthy lifestyle, or cured if detected early enough. Cigarette smoking is estimated to have caused 11,308 new cancers and 8,155 cancer deaths in 2005.
Some simple lifestyle changes - quitting smoking, maintaining a healthy diet, reducing alcohol consumption, more exercise and protecting yourself in the sun - can help to reduce your risk of developing cancer.
Cancer incidence
Cancer occurs when genes that are damaged or faulty cause cells to multiply uncontrollably and form a mass (sometimes known as a tumour). Cancer cells can break away from the mass (or tumour) and travel via the bloodstream or lymphatic system to different parts of the body and form new masses there. Cancer can cause premature death because these masses of cells stop parts of the body from working properly.
Treatments
Some cancers can be cured if the tumour is detected and surgically removed before the cancer cells spread. Chemotherapy (anti-cancer drugs) and radiotherapy (radiation treatment) can also treat cancer successfully, by killing cancer cells or stopping them from multiplying. Often these treatments are most effective when used together.
New ways of treating cancer are always being developed and tested. For example, tamoxifen is a highly effective form of endocrine therapy that has been the mainstay in reducing mortality from breast cancer for over two decades. Newer endocrine agents known as aromatase inhibitors are now proving even better. Trastuzumab, an antibody, is showing great promise in the management of breast cancer.
In the future, we will see increasing development of therapies that specifically target cancer. They will block cancer cells' signalling pathways, disrupt their blood supply, correct genetic defects which cause cancer, and assist the body's immune system to fight cancer.
Prevention
More than a third of all cancers are preventable through lifestyle changes. One in five cancer deaths in Australia is due to cigarette smoking alone. Evidence shows that being overweight, having a poor diet, drinking alcohol and doing little or no exercise all increase your risk of developing certain cancers. A further 10 per cent of cancers are melanoma, a potentially fatal skin cancer but which is mostly preventable. If you follow these recommendations you will reduce your risk of cancer:
- Don't smoke. If you do smoke and want to quit, Quitline can help you: call 131 848
- Eat plenty of plant foods: at least two servings of fruit and five serves of vegetables per day and several serves of such foods as breads, cereals, grain products, pasta and rice
- Eat low-fat foods. Don't eat too much meat, especially high-fat or processed meat. We recommend slow cooking methods; some research suggests that consumption of burnt of charred meat may increase cancer risk, though the evidence is not conslusive
- Exercise for 30 minutes or more on most days of the week. A higher level of exercise, such as 60 minutes or 30 minutes high intensity, may have additional benefit
- The ideal is not to drink alcohol, but otherwise drink alcohol in moderation: no more than 1 standard glass per day for women and 2 standard glasses per day for men
- Protect yourself against ultraviolet radiation in sunlight by wearing a broad-brimmed hat, long-sleeved shirt, sunglasses and sunscreen, and by staying in the shade where possible during the middle of the day. Avoid solarium tanning machines, which also transmit harmful UV radiation.
Early detection
Many cancers can be treated successfully if they are treated early. Cancers of the breast, cervix and bowel can all be detected early by screening asymtomatic people in specific age groups. Government breast and cervical cancer screening programs have been available to Australian women for a number of years, while a bowel cancer screening program for all men and women aged 50 and over is being incrementally introduced.
Mammography can detect cancerous lumps in the breast, which may not be able to be seen or felt. The BreastScreen Australia program invites all Australian women aged 50 - 69 to have a mammogram every two years. Women aged 40 - 49 and 70 and over can also seek screening through the program. Some women who have risk factors for breast cancer (for example, a personal or family history of breast cancer) should have mammograms more frequently.
The National Cervical Screening Program currently encourages all women to have a pap test every two years. Women who have a history of cervical cell abnormalities should have more frequent Pap tests.
A new vaccine, developed in Australia, protects against two strains of human papilloma virus, which causes 70 per cent of cervical cancers. The vaccine is now available through the National Immunisation Program. The vaccine does not replace the need for regular Pap tests.
The National Bowel Cancer Screening Program is being progressively implemented and is currently available to Australians who turn 50, 55 or 65 years of age between January 2008 and December 2010. Those who are eligible are sent a letter inviting them to participate in screening by completing a simple test in the privacy of their own homes and mailing it for analysis.
Prostate cancer detection is more complex, as there is no screening program. Men concerned about prostate cancer should speak to their general practitioners.
GPs can also detect and treat common non-melanoma skin cancers and can advise patients concerned about potentially life-threatening skin cancers such as melanoma.
Advice
Cancer Council Helpline is a free, confidential telephone information and support service run by Cancer Councils in each state and territory. Specially trained staff can answer questions about all aspects of cancer, including prevention, early detection and treatment. They can also assist with practical and emotional support and advise callers about specific services appropriate to their needs and location. Information about cancer can also be mailed to callers.
Most states provide resources suitable for teachers, students or people seeking general information, as well as patients and their families. Health professionals may also use the service to access up-to-date information or to help patients.
Call Cancer Council Helpline: 13 11 20 (local call cost from anywhere in Australia) between 9am to 5pm, Monday to Friday. Some states have extended hours; some have health professionals on staff and some have multilingual services.
Links to and/or contacts for further information
Australian sources
Cancer Council Australia also has a series of fact sheets on lifestyle, early detection and diagnosis of cancer.
International sources
Reviewed and updated April 2009
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