Cancer in the UK.

Two million people are living with cancer in the UK today, costing the UK economy £15 billion a year due to early deaths, patients taking time off work, treatment on the NHS and the cost of unpaid care. The Macmillan charity estimates that the average cost to cancer patients is around £570 a month. This figure includes loss of income, the costs of medical appointments and prescriptions, and extra heating costs. In addition, there are social and psychological costs: cancer sufferers often experience social isolation, anxiety resulting from loss of income, and further physical as well as mental health problems.

 The link between the incidence of cancer and socioeconomic deprivation is well known. Deprivation increases the likelihood of smoking, alcohol consumption and obesity. All are major causes of cancer. In the UK, cancer rates in some of the poorest areas are three times greater than in the most affluent (Table 11.4). Glasgow has the highest cancer rate of any UK health authority and it is no coincidence that in the wider central Scotland region over half the population lives in wards which are among the 20 per cent most deprived in the UK. This association between deprivation and cancer is also strongly entrenched in former industrial areas in northern England, south Wales and London. Of the 50 most deprived small census areas in England, 34 are in the northwest region and 17 in the Merseyside conurbation alone. Significantly, the two health authorities with the highest cancer rates in England, Liverpool and Manchester, are in the northwest region.

Cancer survival rates are also affected by socioeconomic status. For all types of cancer there is a deprivation gap, with the more affluent having better survival chances than the most deprived. For example, 14.2 per cent more women in the ‘most affluent group’ survive bladder cancer compared with their most deprived counterparts. This difference is largely explained by pre-existing health status and speed of diagnosis.

Although some cancers are caused by occupational and environmental hazards such as exposure to radiation, toxic chemicals or asbestos, most are related to lifestyle. Increased risks of cancer are associated with obesity, poor diet, lack of exercise, smoking and alcohol abuse. Largely as a result of changing lifestyles, since the 1970s cancer rates in the UK have risen by 23 per cent for men and 43 per cent for women.

Cancers associated with lifestyle choices are preventable. Sunbathing and the use of sunbeds, for example, indicate a cultural preference for a tanned ‘look’, despite the evident risks of skin cancer. Also opportunities for sunbathing have increased in the past 50 years, with growing wealth and the advent of affordable package holidays to destinations such as the Mediterranean and Florida. Along with wealth comes changes in diet and a preference for meat and dairy products, fast food and pre-packed ‘ready’ meals – changes which are linked to a rise in the incidence of bowel cancer. And with higher incomes, alcohol consumption invariably rises, increasing the risks of oral, oesophageal and liver cancer. Finally, lack of exercise and more sedentary lifestyles, together with changes in diet, have driven an epidemic of obesity in the UK and other ACs and increased risks of cancer and CVD. Despite a decline in the popularity of smoking, it remains the biggest single cause of cancer among both men and women. Nearly one-fifth of all cases of cancer diagnosed each year are smoking related.

The UK government’s targets in its fight against cancer are to save 5000 lives a year, increase survival rates and reduce the gap in survival rates that currently exists between the UK and other European countries.

The strategies employed to achieve these targets are both direct and indirect. Direct strategies include investment in advanced medical technology, such as more precise forms of radiotherapy, and diagnostic methods such as endoscopy for early diagnosis and intervention. Mass screening for breast, cervical and bowel cancer is already well established and has proved highly effective.

However, survival rates could be improved further by reducing waiting times between diagnosis and treatment and by giving more support to GPs in referrals to consultants. Meanwhile, cancer research focuses on improving understanding of the disease, developing new treatments, discovering new drugs and exploiting the potential of genetic engineering. Indirect approaches emphasise changes in lifestyle and cancer prevention. Education and health campaigns informing the public of the dangers of smoking, excessive drinking and unbalanced diets can reduce the incidence of preventable cancers.

International agencies and charities are also involved in the fight against cancer. The International Agency for Research on Cancer is part of WHO. It conducts epidemiology and lab research into the causes of the disease. Cancer UK is a charity that researches the prevention, diagnosis and treatment of cancer. Funded by donations, legacies and charity events, it operates at hospitals and universities throughout the UK.

Skin cancer has increased significantly in the past three or four decades and current rates of skin cancer show a year-on-year rise of 3 per cent. The government has intervened directly by legislating to control the commercial use of sunbeds, with age limits for users, and standards of supervision and staff training. Direct clinical treatment involves surgery to remove malignant melanomas and chemotherapy. Publicity campaigns warn of the dangers of sunbathing and the unsupervised use of sunbeds, and advise on sunscreens, clothing and self-examination for cancerous lesions. During the summer months the Meteorological Office Advice regularly issues forecasts on UV intensities and safe limits of exposure. Skin cancer is a preventable disease, which can be controlled by modifications of behaviour and attitudes towards tanning.