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One in four cancers preventable – but first we need the willpower

Cancer is one of the most common public health threats facing Australians and accounts for nearly one-fifth of the disease burden in this country. The direct cost to the Australian community is approaching…

Better diets and more exercise could prevent 43,000 cancer diagnoses a year. joshbousel

Cancer is one of the most common public health threats facing Australians and accounts for nearly one-fifth of the disease burden in this country. The direct cost to the Australian community is approaching $4 billion per year.

Unless we do something now, this burden will increase. Rates of new cancers are expected to rise sharply over the next decade simply because our population is growing and ageing. This will place extra pressure on health-care management, support and follow-up services.

But there is hope. Despite their high burden, chronic diseases are the most preventable. Less than 10% of cancers are due to genetic or inherited disorders, meaning at least nine in ten cancers are due to external factors – many of which are not understood.

Fortunately, the impact of some of these risk factors is well known. In a recent international collaboration of scientific experts, the World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) estimated that 25% of cancers could be prevented if we eliminated poor nutrition and diet, physical inactivity and obesity.

Motivating Australians to get active won’t be easy. Andy in NYC

Motivating populations to take action is very difficult and will require a concerted and significant effort – not only by the population themselves, but by governments and policy makers Australia wide. But such an effort is unlikely unless lifestyle change becomes a strong priority. First, we need some context.

In our paper, published in today’s Medical Journal of Australia, we tried to estimate what the impact of this 25% could be in 13 years, in 2025.

Of course, any projections are fraught with uncertainty, so we kept our calculations simple. We based our cancer predictions on population projections published by the Australian Bureau of Statistics. This is consistent with that used recently in a large study from the United States.

Using this method, we estimated that around 170,000 Australians could expect a cancer diagnosis in the year 2025 (up from 108,000 in 2007). This correlates with a recent Australian Institute of Health and Welfare estimate of 150,000 in 2020 .

One quarter of 170,000 equals about 43,000 people. So, if we can put steps in place to reduce poor diet, increase physical activity and reduce obesity, then potentially we could prevent the equivalent of the population of a city the size of Port Macquarie from being diagnosed with cancer in 2025. And not just in 2025, but every year after that.

Governments need to invest in interventions that promote healthy lifestyles. Experience LA

It won’t be easy. Latest figures suggest the prevalence of sedentary behaviour, excess weight and obesity, and harmful alcohol consumption is generally increasing. Australians also have a culture of low consumption of fruit and vegetables. So, much needs to change.

Clearly, despite our efforts to improve lifestyles, people will still be diagnosed with cancer. So any prevention efforts need to be taken in conjunction with continued improvements in the detection and treatment of cancers.

But when you consider the costs of treatment, prevention offers substantial hope to reduce the burden of cancer using a sustainable method. And lifestyle-based cancer prevention can also reduce rates of other chronic diseases such as diabetes, hypertension, heart disease and stroke.

We know that for many people diagnosed with cancer, their prognosis depends on where they live. Areas with poor outcomes are also generally characterised by poorer diet, lower physical activity and high levels of obesity. A focus on prevention in these disadvantaged areas, and removing existing barriers to those prevention efforts, has the potential to reduce these current inequities in cancer outcomes.

Designing and implementing interventions in diet, nutrition, physical activity and obesity at a population level are not simple. Nor are they inexpensive. Even small changes at the individual level require a large amount of effort by governments. Interventions require long-term commitment, with results only evident 10 to 15 years later.

But given just over 2% of Australia’s total health expenditure in 2007-08 was spent on preventive services or health promotion, the potential is high.

If we are going to have any impact on reducing the significant human and financial burden of cancer in the future, governments and policy makers at all levels must act now.

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10 Comments sorted by

  1. James Jenkin

    EFL Teacher Trainer

    I'm curious what the proposed additional health promotion will actually say.

    It's likely every adult Australian knows that pumpkin is better for them than a burger and fries.

    The authors stress 'government must act now'. Well, actually, it would be useful to hear some good ideas first.

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    1. Peter Baade

      Senior Research Fellow at Cancer Council Queensland

      In reply to James Jenkin

      James, I agree, and that was a primary motivation to publish this article, to hopefully prompt further discussion on what can be done.

      At the end of the day it is individuals who need to take responsibility for their own actions, their own diet and exercise levels. However governments have a unique capacity to coordinate and facilitate the required discussions and interventions. The experience with cigarette smoking prevalence in Australia demonstrates what is possible with a coordinated and long term committment on the part of governments, policy makers and individuals.

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    2. Clifford Chapman

      Retired English Teacher

      In reply to Peter Baade

      In that case, Peter - I mean in regard to your comments about individuals taking responsibility for their own actions and governments having a unique capacity - would you agree that Australia should ban smoking and become a sort of front-runner for making this obscenity the reality it is? After all, the morally bankrupt tobacco companies spent god knows what millions tying to over-turn the plain package legislation we are hoping to achieve, and they just love using young children in Asian and African countries on which to hook their disease-ridden product.

      If I'm one of the people who needs to take responsibility for my actions, as you infer, doesn't that also apply to Members of Parliament, nay, more so, since they have more power to make things happen?

      I can choose to purchase a packet of this legalised filth from a Supermarket, but they can choose to make those purchases impossible. Who, then, has the real power?

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    3. Jan Burgess

      Retired

      In reply to James Jenkin

      A very simple and low-cost start would be to mandate that every school (primary and secondary) demonstrate and teach healthy lifestyles. This would include all schools to have a vegetable garden, teaching children how to produce fruit and vegetables. Schools to provide nutritious meals (no junk food). Schools to teach healthy cooking to all students. Mandatory exercise periods every day at school. The list goes on. We all know what should be on it.

      If parents can't or won't teach their children…

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  2. Dale Bloom

    Analyst

    I’ll give a possible solution to the problem.

    The medical profession develops courses for weight loss/ good eating/ exercise etc, and these programs are then run by private companies. If someone needs weight loss/ better eating/ better exercise etc, the doctor sends their patient to the private company to be on a course.

    The patient also pays for the course themselves, but the course teaches the patient how to save money so they can pay for the course (e.g. the course might teach the patient how to eat healthy but cheaper food, which is less expensive than takeaway food etc).

    So the patient pays for the course, but it doesn’t cost them any extra money, they develop a healthier lifestyle, and it doesn’t cost the taxpayer anything also.

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  3. Felix Lawrence

    logged in via email @gmx.com

    Are dollars a suitable way to measure the cost to society of these (or any) cancers?

    We all want to live longer, and for that reason this kind of research is very important. But is it really valid to claim the benefits as "reducing the significant human and financial burden of cancer in the future", when death is inevitable? In practice, won't preventing or delaying some of these cancers merely delay the burden to the health system/society for a few years?

    Surely when selling such research's benefits, the focus should entirely be on the potential to buy 25% of cancer victims a few extra years of enjoyable living.

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    1. Peter Baade

      Senior Research Fellow at Cancer Council Queensland

      In reply to Felix Lawrence

      Hi Felix - while death in inevitable as you suggest, cancer does not only take the life of people who have already lived beyond the average life expectancy, it causes death among people of all ages.

      However these projections are not about deaths, they are about new diagnoses of cancer. Each cancer requires (often costly) treatment and follow up, there is also substantial psychological burden and often physical limitation associated with a cancer diagnosis and associated treatment.

      Surely it is better taking steps to prevent this happening for many people in the first place?

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  4. Guy Hibbins

    Clinical evaluator of therapeutic goods at Monash University

    The former FDA Head and Dean of Yale and UCSF medical schools, David Kessler, wrote a book called "The End of Overeating" in which he outlines how a multibillion dollar processed food industry has hundreds of food technology scientists devoting their entire careers to developing "hyperpalatable" foods which are unnaturally high in fat, sugar and salt. (These three ingredients in high concentrations are what Kessler says are known as the three points of the processed food industry compass).

    The…

    Read more
    1. Clifford Chapman

      Retired English Teacher

      In reply to Guy Hibbins

      Does he give any information on government action, which could, at the stroke of a pen, ensure companies could not behave so unethically, or does he just recognise that governments are generally morally bankrupt?

      Perhaps he doesn't even mention them?

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  5. Sue Ieraci

    Public hospital clinician

    "Cancer is one of the most common public health threats facing Australians and accounts for nearly one-fifth of the disease burden in this country."

    This paper neglects the big non-preventable factor in cancer deaths - increasing longevity.

    I am all for promoting a healthy lifestyle and avoiding carcinogens. We need to be honest, though, and publish both heart attack and cancer statistics by age group. There is no doubt that living longer, in association with vaccination, will make cancer a much more prevalent cause of death than infectious disease. OF course, where possible, carcinogens should be avoided.

    Let's not pretend, though, that life is getting somehow more "dangerous". On the contrary.

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