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Scottish Cancer Prevention Network | Putting Prevention First

Getting to know your neighbours

Ireland and Scotland are neighbours who have many cultural and population similarities: native Celtic language, the unique similar national sports of hurling and shinty, the need to always pack an umbrella and a battle to reduce rising cancer incidence due to modifiable risk factors. 

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The Irish Cancer Society (ICS) have long standing links with the Scottish Cancer Prevention Network (SCPN) and introduced the Irish National Cancer Control Programme (NCCP) to the SCPN, growing a cancer risk reduction neighbourhood.  The NCCP and the SCPN are neighbours getting to know each other which can provide immense benefits to reducing cancer risk for both our nations. 

      Learning from each other

The SCPN recently travelled to Dublin to meet stakeholders with an interest in cancer prevention in Ireland.  Learning from the actions undertaken by the SCPN a similar approach could meet the aims of the NCCP by bringing a collaborative and focused approach to cancer prevention in Ireland, facilitating peer learning and supporting national and local cancer risk reduction initiatives.  Likewise a workshop held after the presentation stimulated new ideas for the SCPN. 

      Resources

Ireland’s cancer risk reduction function won’t be borrowing a cup of sugar from the SCPN but may borrow “Dougal the dog” for a walk to promote physical activity to reduce cancer risk in Ireland. 

      Support

The actions to reduce cancer risk for individuals, such as eating a diet rich in fruit, vegetables and wholegrains requires support from your neighbour.  If you are trying to eat healthy and your neighbour calls over with freshly picked strawberries or a box of chocolate, which is the support you are looking for?  Creating the link between the SCPN and the NCCP provides a platform to support each other in our endeavours to support and empower cancer risk reduction for our populations.

Over the coming time we hope the link between Ireland and Scotland cancer risk reduction endeavours are strengthened, to learn and support each other.  The Irish cancer risk reduction neighbourhood is strengthening, the SCPN were welcomed to the NCCP by the Irish Cancer Society, Marie Keating and Breakthrough Cancer Research, a community coming together.

Take care of your neighbours and the world will look after itself” is an age old saying that has a depth that extends to world of cancer risk reduction.

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Be active in everyday life – evidence, actions and communications

The third expert report on Diet, Nutrition, Physical Activity and Cancer provides the most comprehensive review on the topic ever published. There is strong evidence that physical activity affect the risk of cancer of the colon, breast and endometrium. The mechanisms involved include reductions in circulating oestrogen levels, immunomodulatory effects, enhancing innate and acquired immunity, and promoting tumour surveillance insulin resistance and inflammation. Physical activity also reduces body fatness, in particular visceral fat, and therefore may have an additional indirect impact on cancer risk. There is more, much more to read on the evidence about Physical activity and cancer in the report.

Key message – we recommend being physically active as part of everyday life – walk more and sit less

But having evidence alone is not enough to change behaviour. A point well made by Professor Mike Kelly in the Guardian, with heart felt words he says… getting people more active is more than drip feeding information and evidence, it requires increasing people’s opportunities to be able to be physically active. It also means helping people to develop motivation and acquire the skills to do the activities. It is about opportunities to be active.

There is a role for information, it’s part of the portfolio to assist change but let us communicate in ways that are remembered, that help sign post, that help motivate and help to make people feel they are engaging in one of lifes great pleasures.

WE asked four UK physical activity communicators to provide us with communications beyond words and you will see below what they sent us. Please share those messages about being active and being alive and help to create the demand for pavements beyond the city boundary green space we can play on and paths we can cycle on. Please share these images widely…. its more than evidence and it’s a contribution to motivating change.

Ann Gates Founder and CEO, Exercise Works!

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Credit: World Health Organization

Dr Paul Kelly Lecturer for Physical Education and Health Sciences, The University of Edinburgh

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Credit: Healthier Scotland Scottish Government

 

Dr Andrew Murray Sport and Exercise Medical Team, The University of Edinburgh

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Credit: Himself

Mary Colvin Senior Health Improvement practitioner, NHS Tayside

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Credit: http://www.everybodywalk.org

Prostate Screening – to screen or not to screen with PSA alone?

The recently published CAP study (1) has a stark message – screening for prostate cancer using a single PSA test doesn’t work – it has no effect on mortality from the disease. This reinforces what we already know from previous trials. True, there is one European trial of repeated PSA testing that has shown a reduction in prostate cancer deaths, but at the cost of having to treat 28 men to prevent one death. As the treatment for prostate cancer causes significant morbidity in the form of urinary and sexual dysfunction, the UK National Screening Committee along with all other competent international organisations, do not recommend PSA screening for prostate cancer. 

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The problem is that, although PSA testing detects cancer, most cases do not progress and are therefore not destined to cause death. Indeed, aggressive prostate cancer often presents in the face of a normal PSA. To compound the problem, symptoms are a very poor indicator of cancer – most men with frequency, urgency and poor stream have benign prostatic enlargement. Of course, some will have cancer as well, picked up by well-meaning PSA testing and subsequent biopsy, and these men will go on to have radical treatment despite the fact that few will benefit.

So what can we do? The message cannot be “don’t screen”, it must be “don’t offer screening with PSA alone”. Given that, in the absence of PSA testing, most aggressive cancer presents with metastatic disease, we need something else that can pick up early significant disease without exposing many men to unnecessary morbidity. Where this will come from is not yet clear, but there is promising ongoing work looking at the value of different levels of PSA, specific age ranges and combining PSA testing with advanced MRI scanning.

  1. Effect of a Low-Intensity PSA-Based Screening Intervention on Prostate Cancer Mortality: The CAP Randomized Clinical Trial (2018) JAMA Mar 6;319(9):883-895 https://www.ncbi.nlm.nih.gov/pubmed/29509864

 

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Prof. Bob Steele

Walk a Mile in My Shoes

The Daily mile… (or in more modern terminology 1.6km) is my daily escape … a goal that became a habit. A quest for improvement in physical health with mental and emotional benefit.

 

In 2000 I used to run once or twice a week in my lunch-break but hassles of time, weather and running kit made it tricky. In a rather unsatisfactory way I started walking at lunchtime – to get away from the phone, people and my e-mail. But I found walking pretty boring, so not an ideal way to keep active during work hours. I needed space so wanted to be alone but not bored… so first came my French lessons – coffee break French became lunch break French! Then I rediscovered music (apparently I sing along louder that I think), then I discovered audible books, then I took longer breaks….

Sometimes, there is silence and I think and often creative ideas emerge- grant applications, SCPN newsletter articles, ideas for pressies. Sometimes my nearest and dearest join me. Sometimes I call a daughter for a blether and catch up. Sometimes, I just enjoy my lovely walk through the Ninewells arboretum, the community garden Maggies centre, the labyrinth garden and back to the office. On average the walk is 23 minutes, it is brisk and my fit bit tells me I use up 162 kcals. What the fit bit doesn’t give me is a metric for my head space, creative thinking and pleasure of being outside (or indeed the vitamin D benefits).

Discover walking …a mile or more … make it a habit.

Annie-Anderson

Annie S Anderson

Do We Forget About Men?

Monday marked the start of #MensHealthWeek 2018, so are WE as a nation doing enough to help men look after their health?!  We know when it comes to health, men are less likely to talk to each other about their concerns and are less likely to visit their GP so here are some, perhaps surprising, facts about men…

  • In Scotland 1 in 4 men (1 in 5 in the UK) dies before the age of 65 (and are more likely than women to die prematurely).1
  • Scottish life expectancy for men is 77.1 years and 81.1 years for women (2014),2 or in another way, on average men are living two hours fewer per day compared to women!1,3
  • Men have a higher risk of getting cancer than women.4
  • Men are less likely to survive cancer compared to women,5 with UK data showing that for cancers shared by both men and women, men are 67% more likely to die.6
  • Around 30% of male deaths are attributable to cancer.5,7

So why do men fare less well compared to women? Let’s think about one example, colorectal cancer, which is a major public health problem in Scotland and the second most commonly diagnosed cancer in both men and women. However, it is also one of the cancers where there is good evidence that in many cases it can be prevented and it has a high success rate when detected at an early stage. Men are at an increased risk of the disease and also have poorer survival. Despite these statistics men are much less likely to take up the invitation for bowel cancer screening, a biennial national programme which is offered to both men and women once they turn 50 (uptake 52.8% men and 59.1% women), and is even lower in men from poorer backgrounds (40.7%).8 Why do we think this is?

It is estimated that 4 in 10 cancers can be prevented largely through making changes to our lifestyle, for example, by not smoking, keeping a healthy weight and eating a balanced diet.9 SO how do men do when it comes to preventative behaviours? Well, we know that men are more likely…

  • to be overweight (BMI >25) and carry dangerous excess fat around the waist,10 but only make up one in ten patients attending commercial weight loss programmes and are under-represented in weight loss trials.
  • to smoke and drink.
  • to consume red and processed meats and are less aware of the link between the consumption of these meats and the increased risk of colorectal cancer.11

 

 

SO is there any good news?

Well yes, some… Men are much more likely to be physically active compared to women, although activity levels do decrease with age. Men actually DO go to see their GP just as much as women – but only after they retire, and a further example to show that men ARE interested in looking after their health is demonstrated by abdominal aortic aneurysm (AAA) screening, which sees 84% of men attending clinic for a one off screen when they turn 65.12

 

 

SO what can we learn from this and how can we help to address the gender gap when it comes to men’s health? We need better, more innovative ways to engage men and communicate both health and cancer prevention messages. Where do men currently receive health information if they don’t talk to each other and only attend their GP once they’ve retired?  Do men need their own equivalent of ‘Women’s Own’? Perhaps we can also learn from the recent movement in Men’s Sheds that are spreading out across Scotland, set up to provide men with a place to pursue practical interests and build social connections, where they are free to pop in for a cup of tea and a chat and spend time in the workshop.13

The key and recurring phrase we hear is “Men don’t talk face to face. They talk shoulder to shoulder”.

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References

Don’t Stop Taking the Medicine

A false positive result – a positive test for occult blood in faeces with no significant disease subsequently found on colonoscopy – is quite a common finding in bowel screening programmes. One of the reasons given for this is that bleeding into the gut could occur other than when colorectal neoplasia is present, including in participants using oral anti-coagulants (OCs) and non-steroidal anti-inflammatory drugs, including aspirin (NSAIDs). Of course, these medicines are commonly used in the 50-74 year old population invited for bowel screening in Scotland.

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Now that faecal immunochemical tests for haemoglobin (FIT) are the first-line investigation in the Scottish Bowel Screening Programme, a very relevant question is whether this newer test, which can detect much smaller quantities of blood than the traditional guaiac-based faecal occult blood test (gFOBT), gives more false positive results in participants taking OCs or NSAIDs.

A number of studies on gFOBT have implied that this interference is a possibility and some have suggested that participants should cease taking these medicines before undertaking collection of faeces for testing. Institution of this imposition would very likely lead to lowering the uptake of screening. On the other hand, it has been postulated that continuing these medicines might have real benefit through increasing the tendency of any neoplastic lesion present to bleed, in turn increasing the positive predictive value of FIT.

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This important question has been addressed in a new, the first, systematic review and meta-analysis on the effect of OCs and NSAIDs on the diagnostic accuracy of FIT in colorectal cancer screening.1

The results show that the use of these medicines does not affect the positive predictive value of FIT for advanced neoplasia (colorectal cancer plus advanced adenoma).  This might be because FIT are much more specific for colorectal bleeding than the traditional gFOBT, since they detect the globin moiety of haemoglobin rather than the haem component:  bleeding from the upper gastrointestinal tract is not detected by FIT due to rapid degradation of any haemoglobin released there. It was concluded that, based on the current literature evidence, stopping taking OCs or aspirin and other NSAIDs before collecting samples for use in FIT-based screening programmes is not recommended. Keep on taking the medicine!

 

 

Reference:

1 Nieuwenburg SAV, Vuik FER, Kruip MJHA, Kuipers EJ, Spaander MCW. Effect of anticoagulants and NSAIDs on accuracy of faecal immunochemical tests (FITs) in colorectal cancer screening: a systematic review and meta-analysis. Gut. 2018 Jun 5. pii: gutjnl-2018-316344. doi: 10.1136/gutjnl-2018-316344. [Epub ahead of print].

Older Persons Guide to Preventing Skin Cancer

May is skin cancer awareness month. Last week we posted our blog the Young Persons Guide to Preventing Skin Cancer written by our local Macmillan skin cancer specialist nurses here in Tayside – Claire Dickson and Amanda Degabriele. Today the team provide some key points for older people…

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  • In Scotland, sun protection must be worn from April to October, even on dull days, UV rays can come through clouds.
  • Avoid strong sunlight between 11am – 3pm (UV index is highest)

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  • Vitamin D is important for good bone health throughout the lifespan and sunshine is a good source – but its doesn’t mean being out in the heat of the day and just a short few minutes in the morning or late afternoon can make a difference.
  • It’s never too late tin life to start using sun protection. You can still prevent sun damage at any age.

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  • Choose suncream/lotion with a sun protection factor (spf) of at least 30 and reapply every 2 hours
  • Remember to apply sun protection prior to sun exposure and throughout the day, especially when enjoying outdoor hobbies.  It is easy to forget how long is spent  outdoors when gardening, bowling, or walking.

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  • Both men and women should wear a wide brimmed hat to make sure that ears and neck are covered
  • Some treatments and medication can increase sensitivity to sunlight, eg. Chemotherapy, Radiotherapy – even after treatments have completed!

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  • Sun Protection Factor (SPF) can be found in some moisturisers.  However, these formulas tend to be less water resistant and are more likely to be applied thinly (and therefore need reapplied throughout the day.)  An alternative approach maybe to try a tinted SPF product but always remember -re-application is needed.

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  • Examine skin every few months for:

Pearly spots. 

Non-healing spots. 

New/ Enlarging lesions (may be pigmented). 

  • If worried about lesions, take photos with mobile phone and repeat after 6-12 weeks to monitor changes.  Seek help if you notice any changes or new moles.

Cancer survivorship – Can we make a difference?

 

My recommended read of the week is the new World Cancer Research Fund (WCRF) Third Expert Report (TER) on Diet, Nutrition, Physical Activity and Cancer launched in London today.  The report is aimed at helping people who are keen to know how to prevent cancer and improve survival after diagnosis.

The report certainly has a lot in it… consolidating all the findings from the continuous update projects (CUP) for primary prevention and in the case of cancer survivorship also reporting recommendations from international organisations.

The evidence base for lifestyle and cancer survivorship is frustratingly complex created by difficulties of measuring exposures at different life points (e.g. before or after diagnosis), different stages of diagnosis and different outcome measures (e.g. progression free survival, quality of life, side effects etc). The evidence on breast cancer survivorship points to having a physically active lifestyle and a diet higher in foods rich in dietary fibre BEFORE and AFTER a diagnosis as being important for reducing the chances of dying earlier after a diagnosis. It is notable that greater body fatness (before and after diagnosis) also has negative effects. Higher intakes of fats and saturated fats don’t look good either…

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My eye was drawn to some new data on risk of overall morality (of pre or post) dietary factors. Vegetables and fish stand out as beneficial and alcohol intake as the opposite. But increasingly evidence is pointing to a dietary pattern rather than single foods and nutrients. Translating this means making whole grains, vegetables, fruits and beans the core part of daily meals, keep processed foods and drinks high in fat and sugar to a minimum (indeed the bare minimum) and eat enough calories to keep our weight in the healthy range. Alcohol is best avoided or limited significantly.

Internationally, physical activity is clearly recommended… and in the case of the American Society for Clinical Oncology (ASCO) guidance is also site specific. Colorectal cancer survivors should maintain an ideal body weight, breast cancer survivors achieve and maintain a healthy weight and increase physical activity and the same for prostate survivors.

Difficult though it may be getting the evidence, it’s even harder to get the evidence into practice. I wonder if any of our hospitals offer meals based on whole grains, beans and veggies… does anyone know models of good practice?

Professor Annie S. Anderson 24th May 2018

 

Young Persons Guide to Preventing Skin Cancer

May is skin cancer awareness month and who better to ask about these issues than our local Macmillan skin cancer specialist nurses here in Tayside – Claire Dickson and Amanda Degabriele.

We asked for some key points about skin cancer for young people living in Scotland and here are the key messages they tell people about daily… Time to pass these on…

Skin Cancer is one of the fastest rising cancers in Scotland. It is the 5th most common cancer diagnosed in Women and the 6th in men  (SIGN, 2017) – we can reduce the risks by following these guidelines;

Sun Protection

When…

In Scotland, sun protection must be worn from April to October, even on dull days, UV rays can come through clouds. 

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Avoid strong sunlight between 11am – 3pm (UV index is highest)

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How…

Use sun cream with sun protection factor (spf) of 30 or above.

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Do not drop SPF factor on holiday to encourage a tan; tan is DNA damage, so keep sun protection factor high.

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Use spray high factor sun lotion products on babies and young children for full coverage (ideal for the little active runners that wont keep still!).

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Outdoor sport people should use sport sun protection products; less nippy on the eyes (AND remember to apply and keep applying throughout sport event).

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Put on sun lotion 20 minutes prior to sun exposure.

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Reapply sun lotion evenly every 2hrs. Reapply after swimming. 

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Babies/ small children should wear UV protected full coverage swimsuits.

Be aware; wet t-shirts: once wet, the sun protected qualities are lost.

Look out for clothing (cotton or natural fibres) that show that the fabric is UV protected.

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Wide brimmed hats cover ears, faces and necks…. Choose wisely.

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Don’t forget about the Sunglasses- a must!

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And…

DO NOT use Sunbeds!! 

Spray tan is safe…. and just as convincing!

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If worried about lesions, take photos with mobile phone and repeat after 6-12 weeks to monitor changes.  Seek help if you notice changes or new moles.

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Still need to be convinced..? Watch this video

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