1. Cancer and How to avoid it QUB Staff wellbeing Initiative Dr Anna Gavin Director, N. Ireland Cancer Registry Queen’s University Belfast 29 th January2014 Happy to answer questions

2.  What is Cancer? and How does it start?  How many types?  Is cancer becoming more common?  Role of Screening for Cancer  What causes Cancer?  What can I do to avoid cancer?

3.  Cancer - lot of different types Brain Head & Neck Gut Breast BoneLeukaemia (Blood) Cervix Kidney Prostate Lung Skin

4.  Common pathway - DNA in cells

5. Normal cells  Grow  Limit growth  Repair DNA damage

6.  DNA damage Genetics- tumour suppressor and activation genes- choose your parents well!  Growth unchecked ◦ Tumour  increasingly likely with age

7. Is Cancer More Common that 20/30/50 Years Ago? YES

9. Cancer deaths, males, UK, 2009 Cancer incidence, males, Northern Ireland (1993-2011)

10. Cancer incidence, females, Northern Ireland (1993-2011) Cancer deaths, females, UK, 2009

11.  Ageing population  Control of other diseases e.g. heart disease, infection  Better Diagnosis  Changing Risk Factors

12.  Lung cancer ◦ 1912 - 12 deaths ◦ 2012 – 1,127 cases

13. More openness regarding cancer

14.  Ageing population  Better diagnosis  Lifestyle - tobacco, diet, less exercise  More awareness of cases in community  Screening

16. 1. Early Stage Disease – easier to treat and better survival – Goal REDUCE DEATHS 2. Some Screening Tests – pick up pre-cancer - Cervical Smear - Bowel Cancer Screening 3, Breast screening - picks up existing cancer Figure: Relative survival of female breast cancer patients diagnosed in 1997-2006 (followed up to the end of 2011) by stage

17. Debate What are the harms and benefits of screening

19. Breast 3 over diagnosed : 1 death prevented Prostate 48 over diagnosed – 1 death prevented Colorectal/Bowel and Cervix – pick up and treat early disease so preventing cancer

21. Estimated Percentage of Cancer Deaths Attributed to Various Factors

23. Oral Lung Larynx Stomach Oesophageal Pancreas Cervix Kidney Bladder

25.  Breast over age 50  Uterus  Kidney  bowel

27.  Normal limits  MEN <37”  WOMEN <31.5”

28.  Heart Disease  Constipation  Obesity  Bowel Trouble  Tooth Decay  High Blood Pressure  Diabetes  Some Cancers  Musculo-skeletal Problems

29.  Use a smaller plate  Expect results over a long period  Eat smaller meals more often  Change cooking method - grill  Don’t crash diet  Increase exercise

31. No Risk

35.  Avoid sunburn  NO sunbeds  Avoid 11am – 3pm  Use shade  Cover up – including hat and sunglasses  Sunscreen – 15 Sun Protection Factor (SPF)  Go early if concerned

36.  Don’t Smoke  Eat 5 or more Fruit/Vegetables per day  Exercise  Avoid sunbeds and sunburn  Maintain sensible weight

37.  Screening when invited – breast, cervix, bowel  Be aware of changes – cough, bowel, skin, weight  Seek medical advice early

38. Council & Steering Group PHA GAIN Trusts CRUK QUB BSO HSCB NISRA Clinicians ORECNI DHSSPSNI Prostate Cancer UK Cancer R&D Focus Macmillan Office for Research Ethics Committees Northern Ireland (ORECNI) Thanks To:

39. Any questions?