tag:theconversation.com,2011:/us/topics/cancer-map-22697/articlescancer map – The Conversation2018-11-28T02:44:39Ztag:theconversation.com,2011:article/1060692018-11-28T02:44:39Z2018-11-28T02:44:39ZCurious Kids: Why do people get cancer?<figure><img src="https://images.theconversation.com/files/247140/original/file-20181125-149311-j6g2ja.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A lot of people have spent a very long time wondering what causes cancer -- and scientists still can't say for certain why an individual person might have it.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/marinadelcastell/15123637900/in/photolist-p3qADA-attcLe-pGzdsK-97nH3D-2jpqDi-8fL2Zr-o5UP3n-8PVW7L-7ojh9A-7g1BVw-288wvGe-VFnJj1-gZtiT-d9FKxv-6gxECD-c2ZWYf-bxZCCW-7y4aZ-7NqN9e-bwAzyD-4Et28P-67FT3v-FdXFg4-26LD9mn-aYXvLv-dAeS22-peG81g-JV6R1a-4KxHrW-aAK5Ry-85pVPw-7Q79FC-fnoz5f-dy4QAh-6Jz4Hm-rmDhi-9JG5DX-9zTWFe-i15x3R-248k8yj-4oedpp-9LC5DU-gjY9U-8U3f5r-fnpAd7-jAnpRv-iVAF-WJ526X-3jjnDe-o1GsGu">Marina del Castell/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p><em>This is an article from <a href="https://theconversation.com/au/topics/curious-kids-36782">Curious Kids</a>, a series for children. The Conversation is asking kids to send in questions they’d like an expert to answer. All questions are welcome – serious, weird or wacky! You might also like the podcast <a href="http://www.abc.net.au/kidslisten/imagine-this/">Imagine This</a>, a co-production between ABC KIDS listen and The Conversation, based on Curious Kids.</em> </p>
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<p><strong>Why do people get cancer? – Sascha, age 8, Hurstbridge, Victoria.</strong></p>
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<p>This is a really tough question, Sascha. Lots of very clever people are working hard to try to answer it. I have worked on this problem for many years, and to be honest it still blows my mind to really think about just how complex it is.</p>
<p>Before we talk about <em>why</em> we get cancer, it helps to understand <em>how</em> we get cancer.</p>
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Read more:
<a href="https://theconversation.com/interactive-body-map-what-really-gives-you-cancer-52427">Interactive body map: what really gives you cancer?</a>
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<p>All living things are made of <a href="https://vimeo.com/259704641">tiny building blocks called cells</a>. In humans there are hundreds of different kinds of cells, all with special jobs to do. They build our various organs like our skin, brain and bones. Some cells (such as brain and bone) can live for many years, while others (like red blood cells) live only a few weeks.</p>
<p>A human body is made up of trillions of individual cells, many more than all the stars you can see in the night sky.</p>
<p>As we grow, our body needs to make new cells. And as cells get old or damaged, they die and need to be replaced. That helps to keep us healthy.</p>
<p>The simplest way to think of a cancer is that sometimes, one of those trillions of cells starts to grow out of control and refuses to die. This out-of-control cell then divides and makes millions of copies of itself. It can grow to form a tumour - or, in some cases such as leukaemia, spreads through our blood.</p>
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<a href="https://images.theconversation.com/files/247627/original/file-20181127-32236-1lp9pv8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/247627/original/file-20181127-32236-1lp9pv8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/247627/original/file-20181127-32236-1lp9pv8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=202&fit=crop&dpr=1 600w, https://images.theconversation.com/files/247627/original/file-20181127-32236-1lp9pv8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=202&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/247627/original/file-20181127-32236-1lp9pv8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=202&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/247627/original/file-20181127-32236-1lp9pv8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=253&fit=crop&dpr=1 754w, https://images.theconversation.com/files/247627/original/file-20181127-32236-1lp9pv8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=253&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/247627/original/file-20181127-32236-1lp9pv8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=253&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">An out-of-control cell can divide and make millions of copies of itself, and can grow to form a tumour.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<p>Cancer cells can also spread to other parts of our body where they would not normally be found. This can cause important organs to stop doing their job and make us very unwell, or die.</p>
<h2>Copying the code - and making mistakes</h2>
<p>The really incredible thing about cells is that they contain the instructions for making copies of themselves. These instructions are stored in a code called the genome, made of a quite beautiful chemical called DNA.</p>
<p>And if you took the DNA from all the cells in a human and lined it all up, it would stretch around the Moon and back six or seven times.</p>
<p>The alphabet cells use to write this DNA code is made of just four different chemical “letters”: A,C,T, and G. And the instructions in each cell are made of about 6 billion of these chemical letters, which need to be copied exactly every time a cell divides to make a copy of itself.</p>
<p>To help you understand this amazing feat of biology, imagine trying to copy the entire Harry Potter book series in handwriting a thousand times over. That’s what a cell needs to do every time it divides, and it’s happening millions of times every day in our bodies.</p>
<p>You can watch an animation of the incredible, tiny machine cells use to copy DNA here:</p>
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<p>With all that DNA to copy, cells are bound to make the occasional spelling mistake - we call these mistakes “mutations”. Sometimes, those mutations change the meaning of a cell’s instruction book, causing it to grow out of control and form a tumour. </p>
<p>This is what we call cancer.</p>
<h2>But why?</h2>
<p>Now, back to the question of <em>why</em> we get cancer.</p>
<p>Different scientists are having a bit of an argument over this question, but it seems to come down to a combination of bad luck and various experiences you might have in life. Things like too much sunshine, certain chemicals (such as tobacco smoke), alcohol, some foods and even some viruses can increase our chances of getting mutations in our DNA.</p>
<p>Because those mutations in DNA take time to build up, cancer is most commonly seen in older adults. Children do sometimes get cancer but thankfully it is relatively rare. Usually, evolution would mean not many people would get such a horrible disease like cancer. But because most people get cancer after they have had kids, evolution is almost blind to cancer. People who might have a higher cancer risk because of their genes live long enough to pass those genes onto their kids.</p>
<p>You can reduce your chance of cancer by making healthy, sensible lifestyle decisions but it is not possible to completely prevent it. Unfortunately, as I said before, it’s at least partly down to bad luck. </p>
<p>Importantly, we can almost never say for sure why an individual person has cancer.</p>
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Read more:
<a href="https://theconversation.com/curious-kids-is-there-anything-hotter-than-the-sun-105748">Curious Kids: Is there anything hotter than the Sun?</a>
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<p><em>Hello, curious kids! Have you got a question you’d like an expert to answer? Ask an adult to send your question to us. They can:</em></p>
<p><em>* Email your question to curiouskids@theconversation.edu.au
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<img alt="" src="https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=376&fit=crop&dpr=1 600w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=376&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=376&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=472&fit=crop&dpr=1 754w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=472&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=472&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em>Please tell us your name, age and which city you live in. You can send an audio recording of your question too, if you want. Send as many questions as you like! We won’t be able to answer every question but we will do our best.</em></p><img src="https://counter.theconversation.com/content/106069/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Darren Saunders receives funding from NHMRC, US DoD, and MNDRIA. He is secretary of Science and Technology Australia.</span></em></p>I have worked on this problem for many years, and to be honest it still blows my mind to really think about just how complex it is.Darren Saunders, Associate professor, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1022562018-09-13T20:34:55Z2018-09-13T20:34:55ZINTERACTIVE: We mapped cancer rates across Australia – search for your postcode here<figure><img src="https://images.theconversation.com/files/235543/original/file-20180910-123134-1j9gaik.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">What trends might emerge when we map cancer incidence and mortality rates across Australia?</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Cancer is among the leading causes of death in Australia. As far too many of us know, its impact on individuals and communities can be devastating. But how does cancer affect Australia overall?</p>
<p>To find out, we visualised a rich data set from the <a href="https://www.aihw.gov.au/getmedia/3da1f3c2-30f0-4475-8aed-1f19f8e16d48/20066-cancer-2017.pdf.aspx?inline=true">Cancer in Australia</a> report produced annually by the <a href="https://www.aihw.gov.au/">Australian Institute of Health and Welfare</a> (AIHW). We asked two experts – Cancer Council Victoria’s Dallas English and Brigid Lynch – to reflect on the picture that emerged.</p>
<p>Here’s what we found.</p>
<h2>Cancer mortality rates are declining overall</h2>
<p>We’ll start with the good news: although the cancer incidence rate has increased by just over a quarter since 1982, the mortality rate has gone down. That’s reflected in the falling mortality-to-incidence ratio.</p>
<p><iframe id="tc-infographic-293" class="tc-infographic" height="470" src="https://cdn.theconversation.com/infographics/293/d5735b4a8527d33d2f2a095b7f9c11bed84f0e43/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>The incidence rate is the number of new cases in a given period (relative to the size of the population). The mortality rate due to cancer is the number of deaths that occurred in a given period for which the underlying cause of death was recorded as cancer.</p>
<p>The <a href="https://ncci.canceraustralia.gov.au/outcomes/mortality-incidence-ratio/mortality-incidence-ratio">mortality-to-incidence</a> ratio is not really the same as a “survival rate” but is sometimes used as a proxy for one.</p>
<p>“So for example, if you look at mortality in 2013 and incidence in the same year, you would see people dying in that year who were diagnosed some time earlier. But, generally, it is a good proxy for survival after diagnosis,” Professor English said.</p>
<p>The AIHW data visualised here show age-standardised cancer rates across a five year period leading up to 2013 (age standardised means the data were adjusted to account for the fact that some areas may have an older demographic, to remove the influence of age on the results). It’s a snapshot in time and depending on the size of the region and the type of cancer, things may look somewhat different in another time period.</p>
<p>Use the drop-down menus below to see how various cancer rates look across Australia:</p>
<p><iframe id="tc-infographic-292" class="tc-infographic" height="1500" src="https://cdn.theconversation.com/infographics/292/fa70ab8de88c58dccc32762ab08c5b4e07e4464e/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
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Read more:
<a href="https://theconversation.com/interactive-body-map-what-really-gives-you-cancer-52427">Interactive body map: what really gives you cancer?</a>
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<p>Professor English said that some of the differences in cancer rates across the country are due to random variation but there are also some trends worth noting.</p>
<p>“Let’s take melanoma, for example. The map shows that if you live in Queensland and northern NSW, the rates are much higher than for people who live in the south, in places like Tasmania and Victoria,” he said. </p>
<p>“If you look at lung cancer on this map, you are basically looking at a map of smoking prevalence around Australia. If you go to the top end – places like Tiwi, West Arnhem – it’s very high because of <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1467-842X.2005.tb00061.x">high</a> smoking <a href="https://www.sciencedirect.com/science/article/pii/S1443950605001319">rates</a> there.”</p>
<p>For some areas, however, the pattern you see on the map reflect other factors. “For colorectal cancer, for example, the incidence and mortality rate looks low in the NT but that could be due to small populations there, spread across large areas,” he said.</p>
<p>The mortality-to-incidence ratio for all cancers mixes together cancers that have a poor survival rate (such as lung cancer) with others that have a better survival rate, he said.</p>
<p>“<a href="https://www.aihw.gov.au/report/lung-cancer-in-australia-an-overview/contents/summary">Lung cancer</a> is much <a href="https://www.cancer.org.au/about-cancer/types-of-cancer/lung-cancer.html">more likely</a> to be fatal than other cancers.”</p>
<h2>Cancer rates in your area</h2>
<p>Search for your postcode to see how cancer rates in your area look. Again, you can toggle between incidence rate, mortality rate and mortality-to-incidence ratio.</p>
<p><iframe id="tc-infographic-294" class="tc-infographic" height="400px" src="https://cdn.theconversation.com/infographics/294/70464c22afe6dc90ba24a65b55c4c172c1c99654/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>However, Professor Dallas English notes that “just because your area has a high cancer incidence or cancer mortality rate, it doesn’t imply you are living in a dangerous area.”</p>
<p>“It’s not as though you live in a cancer cluster. These rates are more determined by the lifestyle and genetic factors of people who live there.”</p>
<h2>Remoteness and socioeconomic status</h2>
<p>A stark picture emerges when you visualise the mortality-to-incidence ratio against socioeconomic status. </p>
<p>The AIHW <a href="https://www.aihw.gov.au/getmedia/3da1f3c2-30f0-4475-8aed-1f19f8e16d48/20066-cancer-2017.pdf.aspx?inline=true">report</a> said that the age-standardised mortality rate for all cancers combined was <em>highest</em> among those living in the lowest socioeconomic group and <em>lowest</em> among those living in the highest socioeconomic group. </p>
<p>Associate Professor Brigid Lynch, a senior research fellow at Cancer Council Victoria said it’s very clear that socioeconomic position has a strong influence on cancer incidence and mortality in Australia.</p>
<p>“The better off people are, the less likely they are to develop most cancers – and they are more likely to survive after diagnosis,” she said. </p>
<p>“We know that socioeconomic position influences cancer in a number of ways including via health behaviours. But these don’t explain all of the influence.”</p>
<p><iframe id="tc-infographic-295" class="tc-infographic" height="1450" src="https://cdn.theconversation.com/infographics/295/0a97a0c530c372c6d49409545ccebd50e695c60d/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>The AIHW <a href="https://www.aihw.gov.au/getmedia/3da1f3c2-30f0-4475-8aed-1f19f8e16d48/20066-cancer-2017.pdf.aspx?inline=true">reports</a> that the age-standardised mortality rate of all cancers combined was higher for Indigenous Australians than for their non-Indigenous counterparts. </p>
<p>“For Indigenous populations in general, cancer survival is <a href="https://canceraustralia.gov.au/affected-cancer/atsi/cancer-statistics">poor</a>. Lower average socioeconomic status is part of that,” said Professor English. “You tend to have people being diagnosed at much <a href="https://canceraustralia.gov.au/affected-cancer/atsi/cancer-statistics">more advanced stages</a> of cancer and Indigenous Australians have, on average, <a href="https://canceraustralia.gov.au/affected-cancer/atsi/cancer-statistics">poorer access</a> to health services.”</p>
<p>“There have been a lot of <a href="https://www.mja.com.au/journal/2014/201/8/cancer-health-inequality-persists-regional-and-remote-australia">studies</a> showing that Australians in remote and regional areas have poorer survival than in big cities, regardless of indigeneity.”</p>
<p>For prostate cancer, the biggest effect on variation in incidence rates is the amount of prostate specific antigen (PSA) testing that goes on, he said, because this test is known to deliver a high rate of <a href="https://theconversation.com/more-harm-than-good-rethinking-routine-prostate-cancer-screening-8612">false positives</a>.</p>
<p>Professor English also said that:</p>
<ul>
<li><p>Breast cancer is more common among women of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4573746/">higher socioeconomic status</a>. That may be linked to the fact that women with higher socioeconomic status tend to have fewer babies or have babies later in life. (The <a href="https://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/reproductive-history-fact-sheet">older a woman</a> is when she has her first full-term pregnancy, the higher her risk of breast cancer.)</p></li>
<li><p>Lung cancer is associated with <a href="https://www.ncbi.nlm.nih.gov/pubmed/16337709">lower socioeconomic status</a>, however it has a high mortality rate across the board.</p></li>
<li><p>The relationship between prostate cancer incidence and socioeconomic status is complicated. It’s important to remember that men who have a high income are <a href="https://www.nature.com/articles/s41598-018-22589-y">more likely to get tested</a>. </p></li>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/stroke-cancer-and-other-chronic-diseases-more-likely-for-those-with-poor-mental-health-100955">Stroke, cancer and other chronic diseases more likely for those with poor mental health</a>
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<img src="https://counter.theconversation.com/content/102256/count.gif" alt="The Conversation" width="1" height="1" />
It’s clear that socioeconomic position has a strong influence on cancer incidence and mortality in Australia.Sunanda Creagh, Senior EditorLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/802722017-08-21T19:19:37Z2017-08-21T19:19:37ZSurgery isn’t the only option for prostate cancer yet many men aren’t offered others<figure><img src="https://images.theconversation.com/files/182182/original/file-20170816-6110-x12i4u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Patients need to be at the centre of consultations about their treatment.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>Australian men with a recent diagnosis of prostate cancer that require active treatment, as opposed to careful monitoring, are often not given all the options available to them.</p>
<p>This means not all men are getting the necessary information and support to make a decision on what treatment is best. A <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1606220#t=article">growing</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/25255713">body</a> of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5289293/">evidence</a> and <a href="http://www.auanet.org/guidelines/clinically-localized-prostate-cancer-new-(aua/astro/suo-guideline-2017)">treatment guidelines</a> support the fact that less invasive radiation therapy is <a href="http://www.europeanurology.com/article/S0302-2838(16)30470-5/pdf">equally effective</a> in curing or controlling cancer as surgical removal of the prostate, known as radical prostatectomy. </p>
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Read more:
<a href="https://theconversation.com/hows-your-walnut-mate-why-men-dont-like-to-talk-about-their-enlarged-prostate-58209">How’s your walnut, mate? Why men don't like to talk about their enlarged prostate</a>
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<p>While all patients see a urologist - the specialist surgeon who does the biopsies and gives the diagnosis - they only see a radiation oncologist if the urologist or GP refers the man on. In this way, the urologist is the gatekeeper to men receiving optimal (or sub-optimal) care. The fear of cancer and a natural emotional response to get it out may lead to a <a href="https://www.hindawi.com/journals/bmri/2017/1467056/">less than fully-informed decision</a> for surgery, and to possible <a href="https://www.ncbi.nlm.nih.gov/pubmed/25728586">regret of this decision</a> later on. </p>
<p>Bias in medicine is a reality, and it is not surprising <a href="https://www.ncbi.nlm.nih.gov/pubmed/10866869">doctors favour familiar treatments</a>. But it is problematic when bias creates a hurdle to men getting accurate, balanced information. There is plenty of evidence men aren’t getting the chance to hear about their radiation therapy options. A <a href="https://www.hindawi.com/journals/bmri/2017/1467056/">recent US study</a> found that men seeing both a radiation oncologist and urologist were six times more likely to choose radiation therapy compared with men seeing only a urologist. </p>
<p>In Australia, the proportion of <a href="https://pcor.com.au/wp-content/uploads/2016/06/PCOR-ANZ-Annual-Report_2016_FINAL.pdf">men receiving radiation</a> is much lower than research on effectiveness of radiation therapy <a href="https://swscs.med.unsw.edu.au/publication/review-optimal-radiotherapy-utilisation-rates-0">would predict</a> if men with prostate cancer were exhibiting truly informed choice. Meanwhile, prostate surgery rates are higher and continue to rise, especially in the <a href="https://www.mja.com.au/journal/2017/207/2/robotic-prostatectomy-took-despite-lack-evidence-and-risks-inequity">case of robotic surgery</a>. </p>
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<figcaption><span class="caption">Prostate Cancer Foundation of Australia.</span></figcaption>
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<h2>The gold standard of care</h2>
<p>The <a href="http://www.croh-online.com/article/S1040-8428%2815%2900112-2/pdf">gold standard of care</a> for prostate cancer begins with the patient and his support person <a href="http://www.europeanurology.com/article/S0302-2838(11)00891-8/pdf">talking with the experts</a> – the surgeon (urologist), a radiation oncologist and a specialist nurse. In doing so, the man is provided with the relevant information and <a href="http://www.urologiconcology.org/article/S1078-1439(15)00566-9/pdf">impartial advice</a> he needs to make an informed decision about his preferred treatment.</p>
<p>Virtually all specialist doctors who treat cancer profess to be part of a <a href="https://canceraustralia.gov.au/clinical-best-practice/multidisciplinary-care/all-about-multidisciplinary-care/multidisciplinary-care-team">multi-disciplinary team</a>, that includes surgeons, medical and radiation oncologists and other experts, and attend meetings where the relevant <a href="https://www.cancerinstitute.org.au/understanding-cancer/cancer-care-tips/cancer-care-team">health professionals discuss</a> patient “cases” to decide on management. These team meetings are valuable, but they are only one aspect of a high quality service. Meetings do not <a href="https://www.hindawi.com/journals/bmri/2017/1467056/">include the patient</a>, the man with prostate cancer, who is integral to the <a href="https://www.ncbi.nlm.nih.gov/pubmed/26957566">decision-making process</a>. </p>
<p>The multi-disciplinary team model <a href="http://nbcf.org.au/about-national-breast-cancer-foundation/about-breast-cancer/stages-types-treatment-breast-cancer/">has been successful</a> in the treatment of breast cancer. There is <a href="http://www.prostate.org.au/awareness/for-recently-diagnosed-men-and-their-families/localised-prostate-cancer/diagnosis/what-are-the-treatment-choices/">nearly always</a> more than one <a href="https://acrf.com.au/on-cancer/prostate-cancer/">good treatment option</a> available for men with prostate cancer, sometimes several. For men with low risk cancers, many may not require active treatment up front (or ever) and are appropriately managed by active surveillance or careful monitoring. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/latest-research-shows-surgery-for-early-stage-prostate-cancer-doesnt-save-lives-81089">Latest research shows surgery for early stage prostate cancer doesn't save lives</a>
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</em>
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<p>But other <a href="http://www.prostate.org.au/awareness/general-information/what-you-need-to-know-about-prostate-cancer/">men with prostate cancer</a> <a href="https://pcor.com.au/wp-content/uploads/2016/06/PCOR-ANZ-Annual-Report_2016_FINAL.pdf">require active treatment</a> to reduce the chance of dying, or suffering symptoms, from cancer. Alternative treatment pathways are very different for the individuals involved, in terms of <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1606221#t=article">patient experience</a>, potential <a href="https://www.ncbi.nlm.nih.gov/pubmed/28324093">side-effects</a>, the need for <a href="http://www.prostate.org.au/awareness/further-detailed-information/understanding-prostate-cancer-treatments-and-side-effects/understanding-surgery-for-prostate-cancer/prostate-cancer-surgery/">additional treatments</a>, and potential <a href="https://www.mja.com.au/journal/2016/204/11/financial-toxicity-clinical-care-today-menu-without-prices1">out-of-pockets costs</a>. This is why the man with prostate cancer has to be the most important member of the team who decides on the treatment.</p>
<h2>Putting the patient at the centre</h2>
<p>Only the patient can weigh up the trade-off between the risk of bowel problems (with radiation therapy) and the risk of urinary incontinence (with surgery). Likewise, the choice between attending the cancer centre for radiation treatment every weekday over several weeks versus hospitalisation and time off work for recovery after surgery. There are many other <a href="http://onlinelibrary.wiley.com/doi/10.1002/cncr.22033/full">pros and cons</a> that may sway a man to prefer one approach over another.</p>
<p>As already mentioned, the <a href="http://www.croh-online.com/article/S1040-8428%2815%2900112-2/pdf">ideal model for decision-making</a> for prostate cancer treatment is that the <a href="http://www.europeanurology.com/article/S0302-2838(11)00891-8/pdf">man has a consultation</a> with a urologist and a radiation oncologist. As the two types of prostate cancer specialists have distinct expertise in different areas, seeing both is the only way men can get complete, <a href="https://www.mja.com.au/journal/2015/203/10/advances-radiation-therapy">up-to-date information</a>. </p>
<p>The man can then consider his options and discuss these with his family and GP if he wishes. The good news is that men can take time to do this, as most prostate cancers are relatively slow-growing.</p>
<p>In the <a href="http://www.clinicaloncologyonline.net/article/S0936-6555(16)00081-9/abstract">United Kingdom</a>, <a href="https://www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=298448">Canada</a>, and <a href="https://www.dukehealth.org/treatments/cancer/prostate-cancer">select centres</a> <a href="http://www.urologiconcology.org/article/S1078-1439(15)00566-9/pdf">including some</a> in Australia, prostate cancer teams do place the man <a href="http://www.croh-online.com/article/S1040-8428%2815%2900112-2/pdf">at the centre</a> of decision-making. But this must become the rule rather than the exception and Australian men should be strongly encouraged and assisted to see all experts.</p>
<p>Ultimately, men need to be empowered in their decision-making through being part of a process that enables and supports them in making fully informed choices. Until then, men who require active prostate cancer treatment need to insist on seeing all the specialists in the area, including a radiation oncologist.</p><img src="https://counter.theconversation.com/content/80272/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sandra Turner is affiliated with Targeting Cancer, an initiative by the Royal Australian College of Radiologists, Faculty of Radiation Oncology, to raise awareness of radiation therapy as an effective and underused cancer treatment</span></em></p>Men diagnosed with prostate cancer should be given all their options for treatment before they make a decision. In Australia today, this isn’t the rule, but the exception.Sandra Turner, Associate Professor, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/753892017-07-03T23:36:33Z2017-07-03T23:36:33ZNew maps reveal cancer levels across Australia, and across the social strata<p>Public health experts traditionally expect to see a very strong pattern of health inequality – the poorer you are, the more likely you are to be unwell and die before your time. But newly available data on cancer incidence rates show that’s not always the case.</p>
<p>Our team at the Public Health Information Development Unit (PHIDU) used data from the Australian Institute of Health and Welfare’s 2012 <a href="http://www.aihw.gov.au/australian-cancer-database/">Australian Cancer Database</a> to <a href="http://phidu.torrens.edu.au/social-health-atlases/maps">map</a> cancer incidence rates across Australia – by state, by socioeconomic status and by remoteness.</p>
<p>We found generally high rates of breast cancers diagnosed for females in the most advantaged areas when compared with more disadvantaged areas. That is, well-off women were more likely to be diagnosed with breast cancer than their less well-off counterparts.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/176549/original/file-20170703-32612-1uzyt5v.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/176549/original/file-20170703-32612-1uzyt5v.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/176549/original/file-20170703-32612-1uzyt5v.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=425&fit=crop&dpr=1 600w, https://images.theconversation.com/files/176549/original/file-20170703-32612-1uzyt5v.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=425&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/176549/original/file-20170703-32612-1uzyt5v.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=425&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/176549/original/file-20170703-32612-1uzyt5v.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=534&fit=crop&dpr=1 754w, https://images.theconversation.com/files/176549/original/file-20170703-32612-1uzyt5v.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=534&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/176549/original/file-20170703-32612-1uzyt5v.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=534&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="http://phidu.torrens.edu.au/current/graphs/sha-aust/quintiles/aust/cancer-incidence-females.html">PHIDU, using data from AIHW/ACD.</a></span>
</figcaption>
</figure>
<p>The same pattern emerged for prostate cancers diagnosed in males – the more well-off a man is, the more likely he is to be diagnosed with prostate cancer.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/176551/original/file-20170703-32585-d0ure7.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/176551/original/file-20170703-32585-d0ure7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/176551/original/file-20170703-32585-d0ure7.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=418&fit=crop&dpr=1 600w, https://images.theconversation.com/files/176551/original/file-20170703-32585-d0ure7.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=418&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/176551/original/file-20170703-32585-d0ure7.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=418&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/176551/original/file-20170703-32585-d0ure7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=525&fit=crop&dpr=1 754w, https://images.theconversation.com/files/176551/original/file-20170703-32585-d0ure7.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=525&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/176551/original/file-20170703-32585-d0ure7.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=525&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="http://phidu.torrens.edu.au/current/graphs/sha-aust/quintiles/aust/cancer-incidence-females.html">PHIDU, using data from AIHW/ACD.</a></span>
</figcaption>
</figure>
<p>However, the numbers also reveal high rates of lung cancer in the most disadvantaged areas. That was true for both men and women. It seems that the less well-off you are, the more likely you are to be diagnosed with lung cancer.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/176552/original/file-20170703-32607-p6qd8n.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/176552/original/file-20170703-32607-p6qd8n.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/176552/original/file-20170703-32607-p6qd8n.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=417&fit=crop&dpr=1 600w, https://images.theconversation.com/files/176552/original/file-20170703-32607-p6qd8n.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=417&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/176552/original/file-20170703-32607-p6qd8n.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=417&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/176552/original/file-20170703-32607-p6qd8n.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=524&fit=crop&dpr=1 754w, https://images.theconversation.com/files/176552/original/file-20170703-32607-p6qd8n.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=524&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/176552/original/file-20170703-32607-p6qd8n.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=524&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Lung cancer incidence rates in Australia among women, by income quintile.</span>
<span class="attribution"><a class="source" href="http://phidu.torrens.edu.au/current/graphs/sha-aust/quintiles/aust/cancer-incidence-females.html">PHIDU, using AIHW/ACD data.</a></span>
</figcaption>
</figure>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/176553/original/file-20170703-32603-1k2n74t.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/176553/original/file-20170703-32603-1k2n74t.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/176553/original/file-20170703-32603-1k2n74t.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=414&fit=crop&dpr=1 600w, https://images.theconversation.com/files/176553/original/file-20170703-32603-1k2n74t.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=414&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/176553/original/file-20170703-32603-1k2n74t.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=414&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/176553/original/file-20170703-32603-1k2n74t.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=521&fit=crop&dpr=1 754w, https://images.theconversation.com/files/176553/original/file-20170703-32603-1k2n74t.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=521&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/176553/original/file-20170703-32603-1k2n74t.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=521&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Lung cancer incidence rates in Australia among men, by income quintile.</span>
<span class="attribution"><a class="source" href="http://phidu.torrens.edu.au/current/graphs/sha-aust/quintiles/aust/cancer-incidence-females.html">PHIDU, using AIHW/ACD data.</a></span>
</figcaption>
</figure>
<p>Lung cancer incidence also increases with remoteness, being 47% higher in the very remote areas of Australia in comparison with the major cities for females and 49% higher for males. On the other hand, there is a 20% lower incidence of breast cancer for women living in areas classified as very remote, when compared with major cities.</p>
<p>Incidence rates for the total cancers are highest in Queensland, driven by very high rates of melanoma of the skin.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/176557/original/file-20170703-32591-42u6q3.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/176557/original/file-20170703-32591-42u6q3.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=390&fit=crop&dpr=1 600w, https://images.theconversation.com/files/176557/original/file-20170703-32591-42u6q3.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=390&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/176557/original/file-20170703-32591-42u6q3.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=390&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/176557/original/file-20170703-32591-42u6q3.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=490&fit=crop&dpr=1 754w, https://images.theconversation.com/files/176557/original/file-20170703-32591-42u6q3.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=490&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/176557/original/file-20170703-32591-42u6q3.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=490&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Cancer incidence rates, persons, by area of population health areas. Darkest colours show highest rates.</span>
<span class="attribution"><a class="source" href="http://phidu.torrens.edu.au/current/maps/sha-aust/pha-single-map/atlas.html">PHIDU, using AIHW/ACD data.</a></span>
</figcaption>
</figure>
<h2>Health and wealth</h2>
<p>Our analysis of cancer incidence rates showed a mixed picture when it comes to the link between how well-off you are and how likely you are to receive a cancer diagnosis. But for many other health indicators, the correlation is very strong: the more disadvantaged you are, the more likely you are to have poor health outcomes. </p>
<p>This analysis of other health data reveals that, despite Australia’s enviable health standing in the international arena, there is a substantial health gap between the most advantaged and most disadvantaged Australians. </p>
<p>Some of this gap can be put down to biology and genetics, individual behaviour, health service access, and the physical environment. But a major contributor to the gap is people’s socioeconomic status.</p>
<p>The inequality is evident in <a href="http://www.phidu.torrens.edu.au/current/graphs/sha-aust/quintiles/aust/risk-factors.html">levels of obesity</a>, <a href="http://www.phidu.torrens.edu.au/current/graphs/sha-aust/quintiles/aust/chronic-disease.html">diabetes</a>, <a href="http://www.phidu.torrens.edu.au/current/graphs/sha-aust/quintiles/aust/chronic-disease.html">circulatory diseases</a> and <a href="http://www.phidu.torrens.edu.au/current/graphs/sha-aust/quintiles/aust/psychological-distress.html">psychological distress</a>. For all of these measures, the problem is greater, and in many cases much greater, among the most disadvantaged.<br>
And there is a striking gap in the rate of premature deaths (less than 75 years of age), whether we look at the <a href="http://www.phidu.torrens.edu.au/current/maps/sha-aust/lga-single-map/aust/atlas.html">capital cities</a>, or <a href="http://www.phidu.torrens.edu.au/current/maps/sha-aust/lga-single-map/aust/atlas.html">regional</a> or <a href="http://www.phidu.torrens.edu.au/current/graphs/sha-aust/remoteness/aust/premature-mortality-sex.html">remote</a> Australia. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/175979/original/file-20170628-25857-15n10ms.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/175979/original/file-20170628-25857-15n10ms.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/175979/original/file-20170628-25857-15n10ms.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=416&fit=crop&dpr=1 600w, https://images.theconversation.com/files/175979/original/file-20170628-25857-15n10ms.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=416&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/175979/original/file-20170628-25857-15n10ms.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=416&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/175979/original/file-20170628-25857-15n10ms.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=523&fit=crop&dpr=1 754w, https://images.theconversation.com/files/175979/original/file-20170628-25857-15n10ms.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=523&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/175979/original/file-20170628-25857-15n10ms.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=523&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Premature death is much more likely for those who are most disadvantaged.</span>
<span class="attribution"><a class="source" href="http://www.phidu.torrens.edu.au/current/graphs/sha-aust/quintiles-time-series/aust/files/pixels.php">PHIDU</a></span>
</figcaption>
</figure>
<p>It is also clear that it is not just a case of a difference between the “haves” and “have nots”. There are more premature deaths at every step across the <a href="http://www.phidu.torrens.edu.au/current/graphs/sha-aust/quintiles/aust/premature-mortality-sex.html">social spectrum</a>.</p>
<p>That is, all but the 20% who live in the most socioeconomically advantaged areas have higher death rates. Public health experts call this the “<a href="http://www.who.int/social_determinants/thecommission/finalreport/key_concepts/en/">social gradient in health</a>”.</p>
<p>What is of greatest concern is that we are seeing a widening in the health gap, as seen in a comparison of <a href="http://www.phidu.torrens.edu.au/current/graphs/sha-aust/quintiles-time-series/aust/premature-mortality-sex.html">premature mortality over time</a>.</p>
<p>Yes, there have been substantial reductions in the rates of early death overall, with rates down by 50% in 2014 when compared with 1987. However, this significant reduction was not shared by all.</p>
<p>The reduction in early deaths was lower for those living in the most disadvantaged areas when compared withe the most well-off areas. In fact, the gap in rates between these population groups has increased, and increased substantially. </p>
<p>The data show us that in 1987 there were 42% more deaths in the most disadvantaged areas compared to the least disadvantaged; by 2013, rates were 76% higher among the most disadvantaged. </p>
<p>Put another way, the current (2013) rate in the most disadvantaged areas, of 256 premature deaths per 100,000 population, was surpassed for those living in the most well-off areas in 1997. </p>
<h2>These are fixable problems</h2>
<p>These are disturbing findings, highlighting a major inequity. This situation, however, is not inevitable. </p>
<p>The socioeconomic environment is a powerful and potentially modifiable factor. Good public policy – particularly in areas such as housing, taxation and social security, work environments, urban design, pollution control, educational achievement, and <a href="https://www.ncbi.nlm.nih.gov/pubmed/12233246">early childhood development</a> – can help make a difference to addressing these problems and reducing the health inequality gap in Australia.</p><img src="https://counter.theconversation.com/content/75389/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Glover receives funding from the Australian government, the Heart Foundation SA and the Foundation for Young Australians.</span></em></p>Public health experts traditionally expect that the poorer you are, the more likely you are to be unwell and die before your time. But newly available data on cancer rates show that’s not always true.John Glover, Director of Public Health Information Development Unit (PHIDU), Torrens University AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/524272016-03-06T19:06:49Z2016-03-06T19:06:49ZInteractive body map: what really gives you cancer?<figure><img src="https://images.theconversation.com/files/109420/original/image-20160127-26823-10cmjm4.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> </figcaption></figure><p>There’s abundant advice out there on what you should or shouldn’t eat, drink, swallow, or stand next to, to avoid cancer. But it’s often lacking in evidence and the jumble of messages can be confusing.</p>
<p>This body map brings together the evidence on proven cancer causes. Using credible, scientific sources it answers questions about whether alcohol, red meat or sun exposure increase your cancer risk.</p>
<p><iframe id="tc-infographic-171" class="tc-infographic" height="400px" src="https://cdn.theconversation.com/infographics/171/30f81a46480b839121f8fdbb1a104cf6322671ef/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Cancer occurs when <a href="https://theconversation.com/explainer-what-is-cancer-1673">mutations in a cell’s DNA</a> cause it to replicate without control, invading other tissues. Some cancer-causing mutations can be inherited; others induced, by infection with bacteria or viruses; or by environmental factors such as smoking, sun exposure and eating red meat.</p>
<p>This map’s focus is on induced factors. They are considered “modifiable” because avoiding them lessens your chance of cancer.</p>
<p>Choose your gender and click a risk factor to see which body area can be affected. Clicking the body region will show you how much engaging in risks such as drinking alcohol, taking the contraceptive pill, or eating pickled vegetables, will increase your chance of certain cancers.</p>
<p>When reading the map, keep in mind that every body and circumstance is unique; one risk factor cannot be considered in isolation when applied to a real life context. </p>
<p>Also remember the percentages portrayed are “relative risks” which are different to “absolute risks”. The difference is explained in <a href="http://theconversation.com/its-all-relative-how-to-understand-risk-in-the-cancer-map-55494">this accompanying piece</a>, which will help you understand what relative risk really means for your chances of getting cancer.</p><img src="https://counter.theconversation.com/content/52427/count.gif" alt="The Conversation" width="1" height="1" />
This body map brings together evidence on proven cancer causes. Using credible, scientific sources it answers questions about whether alcohol, red meat or sun exposure increase your cancer risk.Emil Jeyaratnam, Data + Interactives Editor, The ConversationSasha Petrova, Section Editor: EducationLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/554942016-03-06T19:06:26Z2016-03-06T19:06:26ZIt’s all relative: how to understand cancer risk<figure><img src="https://images.theconversation.com/files/113686/original/image-20160303-9466-1kzdm23.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Relative risk is your risk compared to that of someone else.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/image_munky/4441517488/in/photolist-7LtWpJ-dzYX1v-4hR1FK-94cVSC-94cMVL-6A6og1-cPi8n5-6A6nv7-azAKLL-64wkdz-6cRjVN-nafGaM-6A2fAV-82bgrW-2MAFc-9pDk3o-5tfjwS-6V5adM-cpTAjA-dx8yoL-cpTvCS-72hcKr-6A6ouG-6A2eoi-3fFVW-cPi4rm-dfXdVp-cpTxj5-9oFrVw-6A6pfu-3f3s7-6A2hjP-6tEhxr-mkris-cpTuhY-6f7HHr-6RctvB-tqu9r-7BTHB7-6L3znG-qXKR9D-mbeLXd-2jSCqc-89sLJi-9rqHj-7gS478-7Jxznd-4eKgwj-6A6oYE-zkEqi8">Alan/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><blockquote>
<p><strong>Absolute risk</strong> is the risk of developing a cancer over a certain period of time.</p>
<p><strong>Relative risk</strong> is the risk one group of people has of developing a cancer compared to the risk of another group.</p>
</blockquote>
<p>The Conversation’s <a href="http://theconversation.com/interactive-body-map-what-really-gives-you-cancer-52427">cancer map</a> shows that the <a href="http://www.ncbi.nlm.nih.gov/pubmed/15096331">risk of bowel cancer is 10% higher</a> for men and women who have one standard alcoholic drink every day, than for those who don’t drink any alcohol.</p>
<p>This is known as “relative risk” and does <em>not</em> mean you have a 10% chance of getting bowel cancer if you drink one drink per day. </p>
<p>As the map says, it means your risk of bowel cancer is 10% higher than the risk of someone who doesn’t drink any alcohol. </p>
<p>This 10% matters not only in relation to someone else, but also in relation to the absolute risk of getting the particular cancer in the first place. If the absolute risk is small, then a 10% increase still doesn’t make your chances of getting cancer very high.</p>
<p>For instance, a man living in Australia has an absolute risk of 10% of developing bowel cancer over his lifetime. If he drinks one beer every day and his risk of bowel cancer increases by 10%, then it only goes up to 11% overall – so not much higher than it was in the first place.</p>
<h2>Absolute risk</h2>
<p>The absolute risk of cancer is the chance of developing a certain cancer over a specified period of time, say in one year or in five years. </p>
<p>That chance will change depending on different factors. The most important is a person’s age. Since most cancers are more common in older age groups, your absolute risk of cancer will be higher as you get older.</p>
<p>One measure of absolute risk is the lifetime risk, which is the absolute risk of a certain cancer over the period of someone’s life. </p>
<p>The graph below shows the risk for men and women who live in Australia getting certain cancers before the age of 85.</p>
<iframe src="https://datawrapper.dwcdn.net/6ahXK/2/" frameborder="0" allowtransparency="true" allowfullscreen="allowfullscreen" webkitallowfullscreen="webkitallowfullscreen" mozallowfullscreen="mozallowfullscreen" oallowfullscreen="oallowfullscreen" msallowfullscreen="msallowfullscreen" width="100%" height="400"></iframe>
<p>Women who have genetic changes in the BRCA1 or BRCA2 genes have around a 60% absolute lifetime risk of developing breast cancer. This absolute risk is high. </p>
<p>But this risk is over a whole lifetime, so a woman with altered BRCA genes who ends up developing breast cancer may not do so until she is in her 70s or 80s. </p>
<h2>Relative risk</h2>
<p>Relative risk compares the risk of cancer in one group of people to that in another group. </p>
<p>The chance of a group with a common risk factor (such as obesity) developing cancer can be compared to the chance of another group of people with a healthy weight. This relative risk ratio will remain constant across the world. But absolute risk will vary depending on how common a cancer is in a particular region.</p>
<p>Relative risk may sometimes be quite high and lead people to believe the absolute risk of developing disease is higher than it actually is.</p>
<p>For instance, a woman from a Western country has a 2 in 100 chance (2% absolute lifetime risk) of developing cancer of the endometrium (lining of the uterus) by the age of 85. </p>
<p>If the woman is obese, her risk of endometrial cancer is twice that of a woman of ideal weight. That is, a relative risk of 2 or 100% greater chance of developing endometrial cancer than a woman who is not obese. </p>
<p>This 100% figure may sound like obese women have a very high risk of endometrial cancer. But, in fact, the risk is still quite low, since doubling the 2% population risk still only makes the absolute risk of endometrial cancer in obese women around 4%. This is still a low probability of cancer.</p>
<p>Be careful not to confuse relative risk with absolute risk and remember the time-frames over which absolute risk can apply.</p><img src="https://counter.theconversation.com/content/55494/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Olver receives funding from
NHMRC, ARC, Cancer Australia</span></em></p>Relative risk is the risk one group of people has of developing a cancer compared to the risk of another group.Ian Olver, Director, Sansom Institute for Health Research; Chair of Translational Cancer Research, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.