preventing cancer diana sarfati director, cancer control and screening research group
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Preventing cancerDiana Sarfati
Director, Cancer Control and Screening Research Group
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Everything gives you cancer?• Up to half of all cancers could be
prevented by changes in lifestyle factors.
• Confusion created by frequent media stories…
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The BIG
8Dart et al. Cancer Causes Control 2012
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1. Don’t smoke• Smoking is number one preventable cause
of cancer
• Causes almost all cases of lung cancer
• Increases cancers of upper airway, stomach, mouth, tongue, liver, cervix, bladder…
• So: Don’t start smoking
• If you smoke, quit. Your risk of cancer starts coming down about two years.
• Plus you reduce your chance of other chronic diseases including heart disease, emphysema and bronchitis
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19961998
20002002
20042006
20082010
20122014
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10
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25
30
CensusNZHSHLS
NZ Adult (age 15+)Daily Smokers (%) 1996 - 2014
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Māori Adult (age 15+)Daily Smokers (%) 2006 - 2014
2006 2007 2008 2009 2010 2011 2012 2013 20145
10
15
20
25
30
35
40
45
CensusNZHS (U)HLS
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Pacific (age 15+)Daily Smokers (%) 2006 - 2014
2006 2007 2008 2009 2010 2011 2012 2013 20145
10
15
20
25
30
35
CensusNZHS (U)HLS
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2. Keep your weight in the healthy range.• Being overweight or obese is one of
the most important risk factors for a number of cancers.
• Increases risk of bowel, breast, kidney, stomach, uterine…
• Plus you’ll reduce your chance of developing heart disease, diabetes, stroke, arthritis…
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Proportion of adults in each BMI category, 2011–2013
Ministry of Health. 2015. Understanding excess body weight. NZ Health Survey.
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Adult obesity rate, 1977*–2012/13
Ministry of Health. 2015. Understanding excess body weight. NZ Health Survey.
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3. Exercise regularly• Will reduce your chances of
developing colon and breast cancers.
• Plus you’ll be at reduced risk of heart disease, diabetes and osteoarthritis.
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Adults who were physically active for at least 30 minutes on five or more days in the last week
Ministry of Health. Key Results 2013/2014: NZ Health Survey
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4. Drink little or no alcohol• Drinking alcohol is related to
increased risk of breast, colon and liver cancers.
• Even a little bit increases the risk
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5. Eat a healthy and varied diet• Keep calories in healthy range.
• Eat plenty of plant-based foods including fruit, nuts and whole grains.
• Keep diet low in salt and processed meats
• Associated with lower risk of cancers of breast, colon, oesophagus and stomach.
• Plus you’ll lower your risk of heart disease and diabetes.
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6. Avoid excess sun exposure• Sun in NZ is particularly harsh.
• Causes thousands of skin cancers every year.
• Keep out of the sun in the middle of the day, wear protective clothing, sun glasses, a hat and sunscreen (you know the drill)
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7. Get regular (evidence-based) screening• There is good evidence that regular,
organised screening reduces risk of dying from breast, cervical and bowel cancers.
• Cervical and bowel cancer screening can actually prevent cancer
• Be aware of risks and benefits of screening.
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8. Avoid chronic infections• Hepatitis B and C cause liver
cancer
• Human papilloma virus causes cervical cancer
• Helicobacter Pylori causes stomach cancer
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1981-86 1986-91 1991-96 1996-01 2001-040
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MāoriPacificEuro
Stomach cancerAge-standardised incidence rates per 100,000: Males 25+ yr
+
Blakely T, et al. (2010) Cancer Trends: Trends in Incidence by Ethnic and Socioeconomic Group, New Zealand 1981–2004. Wellington
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What causes stomach cancer?
Stomach cancerHelicobacter Pylori
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Estimated seroprevalence of H Pylori by birth cohort and ethnicity in New Zealand
1926-40 1941-55 1956-70 1971-850%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
PacificMāoriEuropean
Birth Cohort
McDonald A, Sarfati D, Baker M, Blakely T Trends in Helicobacter pylori infection among Māori, Pacific and European birth cohorts in New Zealand. Paper under review
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0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
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4.5
1926-40 (40-79yo)
Māori Pacific
RR
McDonald A. Casting a long shadow: the role of household crowding on Helicobacter pylori infection, and excess stomach cancer incidence among Māori and Pacific people. Masters dissertation 2013. (Paper in preparation)
Contribution of H pylori to stomach cancer
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What causes stomach cancer?
Stomach cancerHelicobacter Pylori
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What causes stomach cancer?
Stomach cancerHelicobacter Pylori
Overcrowding in childhood
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What causes stomach cancer?
Stomach cancerHelicobacter Pylori
Overcrowding in childhood
DeprivationIncome
ColonisationImmigration
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Click icon to add picturePreventing cancer…
Dahlgren, G and Whitehead, M (1991)
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The Big 8• Don’t smoke
• Keep your weight in the healthy range.
• Exercise regularly
• Drink little or no alcohol
• Eat a healthy and varied diet
• Avoid excess sun exposure
• Get regular (evidence-based) screening
• Avoid chronic infections
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Other causes• Occupational• Asbestos, heavy metals, many other
individual exposures
• Environmental• Arsenic contamination, Aflatoxins in
foods, Indoor air pollution, Asbestos
• Immunosuppression
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