Health Promotion/Cancers

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Cancers

Information updated February 2006

Maureen Sayer
Senior Health Promotion Officer - Breast/Cervical/Skin Cancer, Bowel Screening and Disabilities
Email: maureen.sayer@liverpoolpct.nhs.uk ||| Tel: (0151) 707 1555 x 105

In the UK the number of people being diagnosed with cancer each year is increasing. Age is the biggest risk factor for developing cancer with 64% of cases diagnosed in people aged 65 and over. One in three people in the UK will develop cancers at some stage in their lives and one in four will die from it (DOH, 2000). Within the NHS agenda (DOH, 2000) cancer has been identified as one of the key priorities. The government has made a commitment to reduce the death rate from cancer in people under 75 years by a fifth by 2010 (Saving Lives, Our Healthier Nation).

Liverpool Health 2001 in their clinical and Health Indicators 2000 shows that cancer accounts for 24% of male deaths and 28% female deaths of all ages.

Breast Cancer

Breast cancer is the most common cancer among women in the UK with over 41,000 new cases per year. This accounts for 30 % (one in three) of all female cancers and 17% of female deaths from cancer in the UK (Cancer Research Uk 2003). Breast Cancer is the most common cause of death in women aged 35-54 years accounting for 17% of all deaths It is estimated that one in nine women In the UK will develop breast cancer at some time in their life (NHS Cancer Breast Screening Programme 2002)

Breast screening can detect breast cancer at a very early stage when the tumour is usually too small to be felt. This leads to a better prognosis than those with more advanced disease. The largest improvements in five-year survival rates have been for women aged 50-69 (Cancer Research UK).

Survival rates for women with breast cancer in deprived areas is lower than those in more affluent areas.

Men can also get breast cancer with 300 men a year being diagnosed.

Liverpool Health Promotion Service is working in several key areas to address this important issue:

Breast Screening coverage in Liverpool in the last 3 years has been at 66.3%. The National Breast Screening Programme in Liverpool was extended to include women up to and including 70 years in January 2005. Women 71 years and over can self refer and there is no upper age limit.
The Merseyside Health Action Zone funded research into Breast Screening and Marginalised Women with Liverpool Hope University. The report ‘Nip It In The Bud’ is available from Maureen Sayer at Liverpool Health Promotion Service, 10 Maryland Street, Liverpool L1 9DE for a cost of £12.00 Please make cheques payable to 'Central Liverpool Primary Care Trust'.

The research identifies the needs of women with sensory impairment, learning disabilities, low literacy skills, travelling communities, social deprivation and black and minority ethnic communities. It also identifies how primary care could more effectively encourage women to attend for breast screening. Work has taken place with black and racial minority communities also the deaf and hearing impaired community to disseminate the research findings. In 2005 new pictorial breast screening leaflets were translated into the main languages: Somali, Urdu, Punjabi, Hindi, Bengali, Arabic, Cantonese and Turkish. They are available from Liverpool Health Promotion Service.
Work will continue with black and racial minority communities to remove barriers to accessing the breast screening services.
The Breast Screening Resource Packs for Primary Health Care Teams have been disseminated across Liverpool Primary Care Trust.
Working in collaboration with Age Concern Liverpool to promote the changes in the Breast Screening Programme to older women. A fourth 'In The Pink' event held at the Active Age Centre, Townsend Lane during Women's Health month in October 2005 promoted breast awareness, screening and assessment through the use of drama. The day continues to encourage women to attend for breast screening including women aged 71 and over. Some studies show that older women with breast cancer delay in presenting with breast cancer. The day also encouraged healthy eating and physical activity. Audio tapes on Breast Screening and Breast Assessment were produced and distributed in 2005 for women who are blind or visually impaired with the support of Liverpool Voluntary Services for the Blind.
Women’s Health month during October 2006 also includes Breast Cancer Awareness month. This is an opportunity to promote breast awareness to women from their teens onwards and breast screening to all women aged 50 plus.
The Breast Screening Working Group and Sub Group on Breast Screening continue to develop strategies and protocols to improve the service. Information on breast screening and breast assessment was translated into Somali, Urdu, Hindi, Bengali, Punjabi, Cantonese, Mandarin, Arabic and Turkish and produced as audiotapes. These audio tapes are available from the Health Link workers at Abercromby Health Centre 708 9370 or from Resources at Liverpool Health Promotion Service 707 1555 ext 102
Breast Screening visits take place at GP practices for the Primary Health Care Teams when their patients are due for three yearly Breast screening to ensure that all practice staff are aware of the process.

Cervical Cancer

Cervical cancer is the 11th most common cancer affecting women in the UK but the 2nd most common cancer in women under the age of 35.The incidence of cervical cancer has decreased since the 1980s with mortality falling by 7% a year. In England in 2001 there were 2,418 new cases of invasive cervical cancer with 927 deaths in 2002.

The National Cervical Screening Programme target for screening is 80%. In the UK there is a national cervical screening coverage of 80.3% over 5 years however screening has been declining across the country in the 25 to 35 year olds. There is a much lower rate of coverage in Liverpool.

Risk factors for cervical cancer are non attendance for cervical screening, certain types of Human Papilloma virus, sexual activity at an early age, many sexual partners (of either partner) and smoking. There is a 30 to 40% higher incidence and mortality rate of cervical cancer in the North West.

Cervical screening checks the health of the cervix and also identifies cervical abnormalities. Treatment at this stage can prevent cervical cancer developing. Cervical screening commences at the age of 25 and women are invited every 3 years until the age of 49. From age 50 screening is every 5 years up to the age of 64 years.

The National Institute of Clinical Excellence recommended that Liquid Based Cytology, which is a new method of examining cervical cells in the laboratory, should commence in England within five years from 2004.The sample taker uses a cervex broom to take a sample of cells from the cervix, which are then placed in a vial and sent to the laboratory to be reported on.

Liverpool’s Primary Care Teams received training on Liquid Based Cytology and are now using either Sure Path or Thin Prep Cytyc, two Liquid Based Cytology companies approved by the National Institute of Clinical Excellence. Liquid Based Cytology has already reduced the number of inadequate results from smear tests because it improves the sensitivity of the test.

The Cervical Screening Working Group and Sub Group continue to develop strategies and protocols to improve the service and uptake of screening.
Work continues on promoting cervical screening to Black and Racial Minority women with roadshows in conjunction with HEAL8, health events, audio tapes and leaflets.

Skin Cancer

There are two main types of skin cancer non-melanoma of the skin and malignant melanoma. Skin cancer is the second most common cancer in the UK. New cases have doubled over the past 20 years. The cause of skin cancer is nearly always due to over exposure to ultra violet radiation from the sun and on sunbeds. Children are particularly vulnerable as sunburn during childhood can lead to skin cancer later in life.

Malignant melanoma Is the most dangerous form of skin cancer with 4,500 cases diagnosed in women (sixth most common cancer in females) and 3,500 case in men in 2002 (twelfth most common cancer in males) in the UK. In 2003 there were 1,766 deaths although the survival rates have continually improved. Melanoma is the second most common cancer in people aged 15-34 years.

It is estimated that four out of five cases of skin cancer are preventable and that up to 80% of malignant melanomas of the skin in the UK are caused by exposure to the sun. A change in the colour, size or shape of an existing mole is the most common symptom of melanoma.

Health Promotion has liased with Environmental Health on the issue of sunbeds. By 2005, 204 solariums had been identified in Liverpool. To increase awareness of sun safety and the dangers of sun beds work was carried out with the South Central School Sports Partnership, and other schools during their Health Awareness events in conjunction with the Cancer Network. Questionnaires completed by year 9 pupils in the South Central Partnership showed 38% of girls and 15% of males used sun beds. In a large comprehensive girls school 60% of year 10 pupils used sun beds, and in another girls school 63% of year 12 pupils were using sunbeds.

It has been estimated that 80% of a persons life time exposure to UV radiation occurs before 21 years of age (Banks et al; 1992)

Useful Links

Cancer BACUP: www.cancerbacup.org.uk
Cancer Screening Programme: www.cancerscreening.nhs.uk
Cancer Research UK: www.cancer.org.uk
Breast Cancer Care: www.breastcancercare.org.uk
Breast Cancer: www.breastcancer.org.uk