INCIDENCE

RISK

Nearly 50,000 people are diagnosed with breast cancer each year in the UK

It is the second biggest cause of death from cancer for women in the UK, after lung cancer

Men can get breast cancer but, it is rare with about 300 men diagnosed annually

The biggest risk factor, after gender, is increasing age – about 81% of breast cancers occur in women over the age of 50

Two genes BRCA1 and BRCA2 give higher risk – about 7% of women have these genes

Smoking, regular alcohol intake, the contraceptive pill, overweight and obesity increase risk

Having more children and breastfeeding for longer than 9 months reduces risk

Breast cancers have been linked to oestrogen

Women currently taking HRT have a 66% increased risk of breast cancer compared to non-users

A woman with one affected first-degree relative (mother or sister) has nearly double the risk of breast cancer of a woman with no family history of the disease; if two (or more) relatives are affected, risk increases further

MORTALITY

SURVIVAL

Breast cancer accounts for approximately 16% of female deaths from cancer in the UK and was the most common cause of death from cancer in women until 1998; since then lung cancer causes more deaths

Those aged 35–54 years, breast cancer is the most common cause of all deaths from cancer

Last 30 years survival rates for breast cancer have been improving

In England for women diagnosed with breast cancer in 2001–2006, five-year relative survival rates have reached 82% compared with only 52% thirty years earlier in 1971–75

SCREENING

SYMPTOMS AND TREATMENT

Breast screening is a method of detecting breast cancer at a very early stage. The first step involves mammogram

The NHS breast screening programme is extending the age range of women eligible to ages 47 to 73

Breast cancer symptoms vary widely but include:

• a lump that can be felt

• change in the breast size or shape

• altered skin texture

• drawing in of the nipple

Breast lumps are, however, common, particularly in younger women; most are not cancerous. About a third of women diagnosed with breast cancer have no symptoms and are detected by breast screening

Diagnosis is made by biopsy

Treatment is usually multimodal and includes:

• surgery

• adjuvant therapy

• radiotherapy

• chemotherapy

• endocrine therapy

• biological therapy

INCIDENCE

RISK

39,991 people in the UK were diagnosed with bowel cancer in 2008

It is the third most common cancer after breast and lung More tumours diagnosed in the left hand side of the bowel, approximately 60% of tumours occur in the sigmoid colon, rectosigmoid junction and rectum

More men than women have colorectal cancer

Large bowel cancer is strongly related to age, the majority of cases arising in those 60 years or older

Incidence rates across the UK vary

Incidence is generally higher in populations with ‘westernised’ diets, these populations also tend to have a higher percentage of overweight and obese people undertaking lower levels of exercise

A lower risk of colon cancer occurs with higher fibre intake Obesity, alcohol intake and smoking are related to an increased risk of colon cancer

A small number of bowel cancers are linked to a dominantly inherited predisposition

MORTALITY

SURVIVAL

16,259 deaths from colorectal cancer in the UK in 2008, comprising 10,164 from colon and 6,095 from rectal cancer Second most common cause of death from cancer in the UK is colorectal cancer after lung cancer

Most deaths occur in older people, approximately 80% in those aged 65 and over and about two-fifths in the over 80s

Globally, colorectal cancer killed more than 600,000 people in 2008, more than half of these deaths reported in the more developed regions

Five-year relative survival rates for male and female colon and rectal cancer have doubled between the early 1970s and mid 2000s

Younger patients have a better prognosis than older patients

Those diagnosed at an early stage have a much better prognosis than those who present with more extensive disease

SCREENING

SYMPTOMS AND TREATMENT

Screening can detect colorectal cancers at an early stage when survival rates are highest

Many colorectal cancers develop slowly over a number of years from adenomas, or benign polyps transforming into malignant adenocarcinomas. Screening provides the opportunity to detect and treat benign polyps before malignant transformation occurs, some polyps turn out to be cancerous when detected

Population screening using the faecal occult blood test every two years can reduce colorectal mortality by between 15% and 18% in people aged 45–74

Men and women of the relevant ages should be invited to participate every two years by using FOBT kits in their own home, returning them to laboratories for analysis

Often the presenting features of colon cancer are non-specific, and include weight loss and anaemia due to occult blood loss

Rectal and distal colon cancers, usually present with bleeding and/or altered bowel habits, symptoms that overlap with less serious and more common conditions

About 20% of patients may present with acute bowel obstruction or peritonitis due to bowel perforation

Main form of treatment is surgery. Other treatments include:

• chemotherapy

• radiotherapy

• biological therapies

INCIDENCE

RISK

About 40,800 people in the UK were diagnosed with lung cancer in 2008

Globally, it is the most common cancer, with 1.61 million new cases diagnosed annually

Until the late 1990s in the UK, lung cancer was the most frequently occurring cancer, it still accounts for around 1 in 8 new cases

There are more cases of lung cancer diagnosed in men, but, the numbers of women being diagnosed has increased

Lung cancer is rarely diagnosed in those younger than 40, the incidence rises steeply after, peaking in people aged 80–84 years. 87% of cases occur in people over the age of 60

Most lung cancers are caused by smoking, 90% in men and 83% in women

The second most important cause of lung cancer after tobacco is radon exposure; this is a naturally occurring radioactive gas. Some of the highest natural levels in the UK are in the southwest

Industrial exposure to certain elements increases risk, for example, arsenic and polycyclic hydrocarbons

Outdoor air pollution maybe be a small risk

A family history of lung cancer in a first-degree relative is associated with a two-fold increased risk, regardless of smoking

MORTALITY

SURVIVAL

6% of all deaths and 22% of all deaths from cancer in the UK are attributed to lung cancer

One person dies every 15 minutes in the UK of lung cancer

75% die at age 65 and over, but due to the large numbers of lung cancer deaths overall, over 4,000 people die from lung cancer before the age of 60

Of all cancers it has one of the lowest survival outcomes, because over two-thirds of patients are diagnosed at a late stage when curative treatment is not possible

A significant difference to survival rates would occur if earlier diagnosis and referral to specialist teams were made

SCREENING

SYMPTOMS AND TREATMENT

There are no screening programmes available

A variety of symptoms are associated with lung cancer, usually relating to the primary tumour. Common symptoms include:

• cough

• dyspnoea

• weight loss

• chest pain

Haemoptysis and bone pain are also relatively common symptoms. Finger clubbing and fever may be present

Surgery is the key curative treatment for Non-Small Cell Lung Cancer and is usually the treatment of choice for early stage patients

Other treatments will depend on the type of lung cancer but, will include:

• chemotherapy

• radiotherapy

INCIDENCE

RISK

37,051 men in the UK were diagnosed with prostate cancer in 2008

It is the most common cancer in men in the UK, accounting for approximately a quarter of all new male cancer diagnoses

Very few cases are registered in men under 50 and about 75% of cases occur in those over 65 years. The largest number of cases occur in the 75–79 age group

At post-mortem examination it is estimated that around half of all men in their fifties have histological evidence of cancer in the prostate. Men are therefore more likely to die with prostate cancer than from it

Prostate cancer risk is strongly related to age

A family history of prostate cancer is a known risk factor for this disease. A history of breast cancer may also affect a man’s risk, specifically if the family members were diagnosed under the age of 60

In the UK, black Caribbean and black African men have about two to three times the risk of being diagnosed or dying from prostate cancer than white men. Generally, Asian men have a lower risk than the national average

There may be a risk associated with smoking and alcohol intake

MORTALITY

SURVIVAL

10,168 men in the UK died from prostate cancer in 2008

The last 30 years survival rates for prostate cancer have been improving and are strongly related to the stage of the disease at diagnosis

In England survival rates have risen from 31% for patients diagnosed in 1971–75 to 77% for men diagnosed in 2001–06

For disease confined to the prostate, five-year relative survival for patients in 1999–2002 is 90% or more, however if the disease is metastatic at presentation five-year relative survival is lower at around 30%

SCREENING

SYMPTOMS AND TREATMENT

The three tests for prostate cancer all have drawbacks, the tests include:

• digital rectal examination

• prostate specific antigen

• transrectal ultrasound biopsy

Localised prostate cancer is usually asymptomatic but some symptoms can arise from enlargement of the prostate gland

Localised prostate cancer symptoms may be the same as those for benign prostatic enlargement:

• frequency

• dysuria

• haematuria

Bladder obstruction may eventually occur if left untreated. Advanced disease may present with pain from widespread skeletal metastases, particularly back pain

Many treatments have serious side-effects

There is no consensus on treatment, decisions are usually based on the risk of disease progression, categorised into low, intermediate and high risk and can include:

• chemotherapy

• radiotherapy

• endocrine therapy

• biological therapy

• surgery

• high-intensity focused ultrasound

• cryotherapy