This week the Centre for Disease Control and Prevention (the CDC) published the results of their research exploring cancer deaths in the Caribbean. This was an interesting piece of work revealing what the common causes of cancer deaths are in the region.

This piece of research looked at 23 Caribbean islands and looked at the most recent five years of mortality data during the period from 2003 to 2013. When they looked at all cancers combined the number of cancer deaths ranged from 32 deaths in the Turks and Caicos Islands to 26,135 in Puerto Rico. They converted the deaths into an age standardised rate which allows a better comparison because this rate takes into account the size of the population and the age of the people in that population. This is important because a larger country will have more deaths simply because they have a larger population and a region with an older population will have more deaths because cancer is more common in older people. By taking these two factors into account we can get an idea of  other underlying factors that may be causing cancer death which could be prevented, or in countries where cancer deaths rates are low we can explore what factors are contributing to this so other countries can learn from this.

When cancer deaths were converted into an age standardised rate it was found that the lowest  cancer death rate was found in the Turks and Caicos Islands at  46.1 cancer deaths per 100,000 people and the highest rate was in St Kitts and Nevis at  139.3 per 100,000 people.

The researchers then looked at specific cancers and they found that across 20 of the Caribbean islands prostate cancer was the most common cause of cancer deaths amongst men accounting for 18.4% to 47.4% of cancer deaths.  This was followed by lung cancer which accounted for 5.6% to 24.4% of cancer deaths.

When they looked at women, breast cancer was the most common cause of cancer deaths in 16 of the Caribbean islands accounting for 14% to 29.7% of cancer deaths.  Cervical cancer was found to be the second most common cause of cancer deaths in women with 4.5% to 18.2% of cancer deaths being attributed to cervical cancer.

The researchers also found that bowel cancer was the third most common cause of cancer deaths in men and women and that overall cancer was second leading cause of death in all islands.

When the deaths rates in the Caribbean were compared to those in the US, it was found that death rates for cervical cancer were  2 – 9 times higher in the Caribbean, prostate cancer death rates were 2 -8 times higher in the Caribbean and lung cancer death rates were lower in the Caribbean.

It was explained, in the publication of the research, that there could be an under or overestimation of the data in the Caribbean for several different reasons such as missing, unknown, invalid and non-specific information. Despite this, important conclusions can be made from this work with researchers concluding that:

“Lung and cervical cancers are important preventable causes of morbidity and mortality in most of the Caribbean countries. Lung cancers can be prevented through primary prevention of exposure to risk factors such as smoking, and cervical cancers can be prevented through human papillomavirus vaccination.

The leading causes of cancer deaths in the Caribbean region for both males and females also can be reduced through screening, early detection, and effective treatment for cervical, breast, and colorectal cancers. Although prostate cancer is the leading cause of cancer mortality among men in the Caribbean, effective screening strategies that result in reduced mortality have not yet emerged globally, highlighting the need for strengthening referral and treatment strategies.”

The Lake Foundation welcomed this research which provides some good insight into areas that require attention in order to improve cancer outcomes in the Caribbean.

Today, Cancer Research UK and Public Health England announced that a recent analysis of cancer data revealed that black women are twice as likely to be diagnosed with late stage breast cancer as their white counterparts. They found that 25% of black African breast cancer patients and 22% of black Caribbean patients had late stage disease compared to 13% of white patients.

The fact that black women are more likely to be diagnosed at a late stage has been known for some time and has also been observed in not just the UK but in the USA too. The Lake Foundation has conducted work in this area to explore the possible reasons behind this. In 2011, we carried out some qualitative research to explore black women’s beliefs about breast cancer and their help-seeking behaviour to determine whether these two factors may lead to delays in diagnosis. Overall our study suggested that, when it comes to seeking help, black women are quite proactive and there would be no delay in visiting their GP (doctor) if they noticed a breast lump; delays in visiting a GP could occur if black women experience other symptoms as they were less aware of these.

We also found that the following factors could delay help seeking in black women: other priorities such as family or work commitments; language barriers; lack of access to information; age (older people are more likely to delay visiting their GP); difficulty getting appointments; cultural insensitivy of the healthcare system, inaction by GPs; and a lengthy referral process. You can read more about this work on our research page (scroll to the bottom of the page).

National data suggests that black women are less likely to take part in the NHS Breast Screening Programme and this could be another reason for the late stage diagnosis. In 2011, our founder Abi Begho worked with Betterdays Cancer Care, the NHS and Cancer Black Care to determine why black women are less likely to attend breast screening and whether patient navigation could be an effective way of improving screening uptake in black women in Peckham and Lewisham. We found that, at the time, black women living in Lewisham and Peckham who were of screening (over the age of 50) were very mobile with many women being unreachable, on an extended trip abroad; having moved from their GP registered address or had relocated and lived abroad,  hence they missed their breast screening appointments. We found that patient navigation was effective at reaching women as numerous and extensive attempts were made to contact women and then support them to attend their screening appointments. You can read more about this work here

Finally, scientific research has also suggested that black women are more likely to develop a more aggressive form of breast cancer which grows rapidly, so this could explain some of the late stage cases. Studies also suggest that black women are more likely to develop breast cancer at a younger age.

This recent analysis by Cancer Research UK has reminded the nation that there is an issue around black women and breast cancer that needs to be addressed. We need to ensure that black women are aware of all the signs and symptoms of breast cancer and that they seek help quickly if they notice any of the symptoms. We also need to understand the biology of the disease and the best ways of detecting and treating the more aggressive forms of breast cancer.

So, the message to black women is:

• Be aware of all the signs and symptoms of breast cancer
• If you’re worried about any symptoms that you have, please visit your doctor as soon as possible
• Eat a healthy diet, keep active and maintain a healthy weight to reduce your risk of developing breast cancer
• If you’re aged 50 or over, consider accepting your invitation from the NHS to take part in breast screening
• Know your family history. If you have a strong family history of breast cancer you may be at an increased risk so visit your GP for some advice and information

A study published in the British Journal of Cancer has found that the effect of combined hormone replacement therapy (HRT) in increasing a women’s risk of developing breast cancer is likely to have been underestimated in previous studies.

HRT is used to treat the symptoms of menopause (hot flushes, mood changes etc) by replacing the oestrogen that is lost during a woman’s menopause. There are two type of HRT, oestrogen only HRT and combined HRT which is mixture of oestrogen and progestogen.

Over the years studies have identified that women using HRT have an increased risk of developing breast cancer but this was only felt to be a slight increase with many stating that the benefits of taking HRT outweigh the risks.  This new study has found that combined HRT actually has a bigger effect on breast cancer risk than was previously thought.

This New Study

This new  piece of work was part of the Breast Cancer Now Generations Study which was set up in 2004 to understand the causes of breast cancer. The full Generations Study is following 113,000 women in the UK for 40 years.

 For this research into the effect of HRT, 39183 women from the Generations Study were selected who were at menopausal age. These women had  been monitored for 6 years through questionnaires which asked a number of questions including questions about their HRT use.

After the six years of monitoring it was found that 775 of the 39,183 women had developed breast cancer. Statistical analysis revealed that women using combined HRT were 2.7 times more likely to develop breast cancer than those who had not used HRT. This applied to use of HRT for a median length of time of 5.4 years and when they explored longer use of HRT, so 15+ years of use, this increased to women being 3.27 times more likely to develop breast cancer. No overall increase in breast cancer risk was observed in women who used oestrogen only HRT.

They also found that the increase in risk returns to almost normal once combined HRT use is stopped. Researchers noted that after a year and also two years of ceasing to take combined HRT there was no significant increase in breast cancer risk.

How Did Other Studies  Result in an Underestimation of Risk?

The underestimation by previous studies occurred because of the way the studies were carried out. Previous studies didn’t comprehensively follow-up with women and document their use of HRT  (e.g. did some women  stop using HRT over the course of the research) nor did they determine the age at which women went through the menopause.  These oversights caused inaccuracies.

What Does this Mean for Women Considering Taking Combined HRT?

Baroness Delyth Morgan, the Chief Executive of Breast Cancer Now said:

“Whether to use HRT is an entirely personal choice, which is why it’s so important that women fully understand the risks and benefits and discuss them with their GP. We hope these findings will help anyone considering the treatment to make an even more informed decision.

 

“On balance, some women will feel HRT to be a necessity. But in order to minimise the risk of breast cancer during treatment, it is recommended that the lowest effective dose is used for the shortest possible time.

 

“The good news is that the increased risk of breast cancer begins to fall once you stop using HRT. “If anyone is at all worried about either HRT or breast cancer, we’d highly encourage you to speak to your GP.”

The Lake Foundation believes that women considering using the combined HRT should have a discussion with their doctor about the pros and cons and make an informed decision about whether to proceed with treatment. If you can avoid combined HRT we would recommend that you do so.

You can download the full research paper below.

 

This week it was reported that Johnson and Johnson, the company that produces talcum powder, has lost a second court case where another woman has claimed that she developed ovarian cancer after using talcum powder for feminine hygiene reasons.

The company has been instructed by a jury to pay a settlement of $55M to the claimant. This case follows a case in February of this year where the family of a women who died from ovarian cancer was awarded $72M after it was claimed that she developed ovarian cancer after using talcum powder for many years.

Johnson and Johnson will be back in court and may face a long stretch of court appearance as it faces 1,200 lawsuits accusing the company of not adequately warning women of the risks associated with using talc-based products.

The question is: is there a risk of developing ovarian cancer from the use of talcum powder? The short answer is, we don’t know.

Cancer Research UK says the following:

“Scientists are trying to see if this is the case, but for now the evidence is still uncertain. However, even if there is a risk it is likely to be fairly small.

 

“Cosmetic body and talcum powders often contain a mineral compound called talc. Several studies have looked at talcum powder use and ovarian cancer. While on the whole the studies have seen a modest increase in the risk of ovarian cancer in women who use talc on their genitals, the evidence isn’t completely clear. So we can’t be sure whether or not talc itself could cause ovarian cancer”

The Chief Executive of the UK’s leading ovarian cancer charity, Ovarian Cancer Action,  has said the following on this issue:

“If you’re currently using talc, don’t panic. Given evidence is inconsistent we do advocate a ‘better safe than sorry’ attitude and advise that women using talc on their genitals stop doing so. But it’s important to remember that the suggested increased risk from using talcum powder is very small.

 

“While the relative increase of a third suggested by some studies sounds significant, the absolute risk of getting ovarian cancer still remains very low. We’re talking about the difference between a 2% risk and a risk of 2.5%.”

This sentiment about using talcum powder for personal hygiene reasons is echoed by the NHS who say:

“Most gynaecologists recommend using plain, unperfumed soaps to wash the area around the vagina (the vulva) gently every day, as opposed to talc or perfumed soaps, gels and antiseptics.” 

The take home message is that there isn’t yet clarity on whether talcum powder increases risk of ovarian cancer and while this uncertainty remains it’s probably better to avoid using talcum powder on the genital area.

We recently read the children’s book My Magic Scarf and were really moved by it so thought we’d tell you about it.

The Magic Scarf is a very touching book that follows the journey of Tanya who is suddenly diagnosed with cancer.  Through Tanya’s story the book teaches children to have a sense of compassion and it creates an understanding of the importance of family, friends and school in helping children cope with a sudden illness.

The book also, very usefully, creates the opportunity to teach children the importance of speaking up if they don’t feel quite right when Tanya states in the story “Always this silly pain”. This is something that she never mentioned to her parents.

We think this is an important book that helps teachers, parents and carers have a useful discussion with children about a very difficult topic.

You can find out more about this book on Amazon.

On Monday, we attended Breast Cancer Care’s reception in Parliament where they launched the findings of their research into the needs of Black, Asian and minority (BAME) women after treatment for breast cancer.   Their research was funded by the Big Lottery Fund and was a collaboration with King’s College London.

This event was hosted by Dawn Butler MP, whose mother and sister were affected by breast cancer. Speaking at the reception, the Chief Executive of Breast Cancer Care  Samia al Qadhi, summarised the findings stating that BAME women felt  a greater sense of isolation after treatment, there was still a significant amount of stigma associated with breast cancer in certain cultures, there is a lack of culturally sensitive support, a number of communication and language issues, and services do not always meet the needs of BAME women.  Breast Cancer Care explained that to address these issues they piloted a new culturally inclusive service in 2015 called PROWESS (Promoting Recovery, Wellbeing, Equality and Support in Survivorship). This service supported the self-management of BAME women after their hospital-based treatment for breast cancer. You can read more about PROWESS here.

Breast Cancer Care stated that policy-makers must consider the needs of BAME women in the implementation of current cancer strategies and ensure that new policies are inclusive and that everyone working in this area has to develop an understanding of how services can be culturally adapted.

During the reception we also heard from Heather Wilson from the Black Health Initiative in Leeds. Ms Wilson was very supportive of the research and its recommendations and stressed the importance of effective partnerships in addressing the issues raised during the research project.

We applaud the work being done by Breast Cancer Care to address the inequalities that exist in this area and look forward to seeing the next phase of this work. We were pleased to have been a part of the working group for PROWESS and hope that this programme will be launched nation wide.

It’s cervical cancer prevention week  (24th to 30th Jan) so it’s an ideal time to remind everyone about the cervical cancer screening test- otherwise known as The Smear.

Cervical cancer is the most common form of cancer in women aged 35 and under and over 3,000 UK women are diagnosed with the disease each year.

The term cervical cancer describes the uncontrolled division/growth of abnormal cells in the neck of the womb (cervix).   In over 99% of cases the cancer is caused by prolonged infection with a high risk strain of a virus known as human papillomavirus (HPV). HPV can spread between peoplethrough skin to skin contact in and around the genital area. HPV infection doesn’t lead to cervical cancer in everyone. However, as it’s such a common virus it is important that we do all we can to help prevent the occurrence or spot early signs of the disease. Below are 3 important steps:

1. Attend you smear test
During a smear test, a nurse or doctor removes a sample of cells from your cervix. These cells are then examined for any changes that might lead to cancer in the future. The process may be uncomfortable but it is over in a short period of time and is important in spotting potential problems. You should normally receive a request to attend a smear test from the age of 25. But if you do not receive one or are below 25 and have any concerns about your cervix – speak to your GP.  Women from ethnic minorities are less likely to attend their smear appointments. This short video discusses the reasons for this.

2.  Be aware of  the symptoms of cervical cancer
Changes to the cells of the cervix do not usually cause symptoms. But if these changes become cancerous they can lead to symptoms such as:

· Unusual bleeding (e.g. during or after sexual intercourse,  between periods, after the menopause)
· Unusual vaginal discharge
· Discomfort or pain during sex
· Lower back pain
· Changes to the frequency of urination
· Blood in the urine
·  Rectal bleeding
· Diarrhoea
· Incontinence
· Leg swelling

Many of these symptoms may be associated with other conditions and have nothing to do with cervical cancer. But it is always best to get them investigated by seeing your GP as soon as possible.

3.  HPV vaccine
Another nationwide programme which helps to reduce the occurrence of cervical cancer is the HPV vaccination programme. The NHS routinely offers vaccinations to girls aged 11–13 in Scotland and 12–13 in the rest of the UK. Girls normally receive the vaccine in school, but they can also receive it from their GP. The vaccine is free for all girls aged 11–17 in Scotland and 12–17 in the rest of the UK.  The vaccine does not offer 100% protection against cervical cancer so anyone who has received it still needs to regularly attend their smear appointments as do all women seeking to prevent cervical cancer.

Please have a look at some women’s experiences of cervical cancer and let us know your thoughts. The smear test may not be pleasant- but is skipping it a risk worth taking?

At the end of last year we conducted a prostate cancer engagement pilot project as part of a large piece of work funded by Prostate Cancer UK to determine the most effective method of reaching the black community with the key messages about prostate cancer.

Local charities were invited to apply for funding to carry out small projects over 3-4 months and we applied for funding to focus on black churches to determine whether, in reality, this is an effective and practical environment to raise awareness of prostate cancer.

Targeting black churches has two main advantages. Firstly, if we take London as an example, a large number of London’s black population attends church regularly. The London Church Census, covering the time period 2005-2012, found that 48% of inner London’s church goers and 21% of outer London’s church goers were black¹.  Based on their figures this equates to 238,158 people from the African and African Caribbean community. This means that by targeting black churches we can reach a significant proportion of the African Caribbean community.

The second advantage of targeting churches is that it provides a very structured environment where a large number of people meet regularly. This, in theory, makes it a convenient environment to deliver health awareness messages. Additionally, many churches have developed their institutions beyond just preaching on a Sunday. Many churches have Men’s Fellowships, Young Professional Networks, Women’s Fellowships, Over 50’s Clubs, Men’s Conferences, Women’s Conferences and social functions. This means that there is the opportunity, in some churches, to select a sub-population within a church that would most benefit from a particular health message.

Whilst there are advantages to targeting black churches there are some logistical challenges. Firstly, churches tend to have a busy programme of events that will have been planned months in advance making it difficult to fit additional events into their schedule. Secondly, the ideal situation would be to deliver a presentation on a Sunday where there is access to the entire congregation, but many churches may not be able to accommodate this.  This means that awareness presentations would have to be delivered on a Saturday or during the week where only a small percentage of the congregation is likely to attend.  Through a flexible approach, being creative with the methods of engagement  and developing  long term relationships with churches it is possible to overcome some of these challenges.

The Lake Foundation being based in Croydon, where there is a diverse population and a significant number of black churches, decided to work locally and target churches in Croydon and the surrounding area.  In our pilot we worked with two churches and explored the best strategy for working with churches to raise awareness amongst their congregations.

From our pilot we  found that:

1. Engaging with black churches can be an effective way of reaching the African Caribbean community with the key messages about prostate cancer because of the potential of reaching large numbers.
2. To reach large numbers in a church setting requires the development of a long-term bespoke engagement programme.
3. There is a need to understand the structure of individual churches to ensure the best strategy is implemented to reach as many of their members as possible.
4. Engaging with churches may include targeting Sunday services for maximum reach and/or organising awareness sessions on a weekday/Saturday to ensure members have a more in-depth knowledge of prostate cancer.

 Recommendations

Overall The Lake Foundation recommended that Prostate Cancer UK explores developing a structured awareness program for African Caribbean churches in the UK or contracting this work out to community organisations. Whilst this may require significant time, personnel and resources we believe it is an effective way of reaching the black community.

Our specific recommendations:

Target Sunday Services

This pilot has shown that targeting Sunday services would ensure large numbers of people are reached but with limited information because of the time constraints of fitting into the Sunday service’s programme

Targeting churches successfully on a Sunday would require two approaches:

• A short presentation during all their Sunday services
• Setting up an information table throughout the day on a Sunday

Specific recommendations:

• Develop a  5-7 minute presentation that could be used for Sunday services
• Develop an easy method to measure the impact of delivering short presentations at a Sunday service
• Be flexible and persistent

Target churches outside of a Sunday service to achieve depth of knowledge

If the aim is to deliver in-depth information about prostate cancer to church goers and if this isn’t possible through a Sunday service due to time constraints then an additional approach will need to be taken.

The pilot has shown that targeting churches through a one-off event (not on a Sunday) is not the most effective method of reaching the largest number of people, this  only reaches a small percentage of a church’s congregation.  Therefore a regular engagement programme is needed.

Specific recommendations:

• Work with individual churches to understand their structure and how best to reach their members
• Identify groups, departments, events and forums within individual churches that can provide an effective environment to raise awareness
• Organise regular events with the same church throughout the year
• Make good use of churches’ communication platforms – social media, website, newsletters, bulletins, TV stations, YouTube channels etc.

We believe that by taking a long-term, flexible and creative approach in targeting churches a significant impact can be made and we’re delighted to learn that Prostate Cancer UK will be launching a new Faith Based Outreach Project using what we learnt from this pilot. We wish them all the very best in this project and hope that is makes a significant difference in increasing cancer outcomes by facilitating early diagnosis and we’d like to thank Prostate Cancer UK for giving us the opportunity to conduct this pilot.

You can download our full report below.

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References

1.       Brierley Consultancy, London Church Census and London City Mission, 2013. London’s Churches are Growing.Kent: Brierley Consultancy

 

A few weeks ago the International Agency for Research on Cancer (IARC) and WHO announced that:

“After thoroughly reviewing the accumulated scientific literature, a Working Group of 22 experts from 10 countries convened by the IARC Monographs Programme classified the consumption of red meat as probably carcinogenic to humans (Group 2A), based on limited evidence that the consumption of red meat causes cancer in humans and strong mechanistic evidence supporting a carcinogenic effect.

This association was observed mainly for colorectal cancer, but associations were also seen for pancreatic cancer and prostate cancer.

Processed meat was classified as carcinogenic to humans (Group 1), based on sufficient evidence in humans that the consumption of processed meat causes colorectal cancer.”

This was picked up by hundreds of media outlets throughout the world with headlines stating that bacon causes cancer.  Today we wanted to take a look at this and get to the bottom of the media headlines.

Firstly IARC and WHO’s announcement wasn’t really new information, a number of research studies over the years have shown that red and processed meats increases a person’s risk of developing bowel cancer and charities like Bowel Cancer UK and Beating Bowel Cancer have been raising awareness of this fact for a number of years.

The wording of the statement and the classification of red and processed meat suggested that bacon and other processed meats were in the same league as tobacco and asbestos but this is not the case and WHO has since clarified this.  They have said whilst they have placed them in the same category “this does NOT mean they are all equally dangerous.”

If we look at global statistics about one million cancer deaths a year are caused by smoking whilst 34,000 cancer deaths are caused by consuming high levels of processed meat and red meat could be responsible for about 50,000 cancer deaths a year.

Research by the World Cancer Research Fund has shown that people who consume the most processed meat have and 17% higher risk of developing bowel cancer that those who consumed the least.

If you put that into the UK context, 21% of bowel cancers are linked to high consumption of processed or red meat, that’s 8,732 cases per year. So by reducing consumption of red and processed meats we can prevent over 8,000 cases of bowel cancer every year.

You may be wondering why red and processed meats increase a person’s risk of developing bowel cancer and to answer that question we have to understand what processed and red meats are. Processed meats are any meat that has been preserved for example cured, salted,  smoked or had a preservative added. This includes bacon, ham, corned beef, pepperoni, hot dogs, salami etc. And, red meat includes beef, pork, lamb and goat; these are meats that are red when uncooked.

It is not entirely clear why red and processed meat increase a person’s risk of developing bowel cancer, but there are some theories. It is thought that processed meats increase risk of bowel cancer because the methods of preserving these meats lead to the development of cancer-causing substances.  When it comes to red meat,  scientist suggest that it may cause cancer due to the molecule that  gives red meat its colour (haem). This molecule may lead to the development of cancer-causing chemicals too. Additionally, cooking both red and processed meat at high temperatures may also generate cancer-causing substances.

The recommendation is that we should all cut down on red meat and avoid processed meat, these can be replaced with white meat or vegetarian options, and we should all be eating more fruits, vegetables and fibre.

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Sources
WHO
International Agency for Research on Cancer
Cancer Research UK
World Caner Research Fund

On Wednesday 5^th August we were delighted to take part in TWYLYTE VIP’s Creative Arts, Entertainment and Networking Summer Event.  This was an excellent event that brought together representatives from the music, film, fashion and media industries and gave us the prefect opportunity to raise awareness of a very important health issue, cervical cancer.

The event was hosted by Jaye of TWYLYTE PR and recording artist Kele Leroc who started the night’s proceedings with live interviews featuring actor Femi Oyeniran (Kidulthood and Anuvahood); Emmanuel Anyiam-Osigwe, the director of the British Urban Film Festival; Nadine Woodley and Dani Mosely writers of the stage play The Forty Elephants; and Martina Barnett from Inside Out.

After the inspirational and informative live interviews we moved on to the ‘FASHION Meets AWARENESS’ Magnetic Fashion Show.  FASHION Meets AWARENESS is the brain child of Celena of Magnetic Fashion Connections and it aims to showcase creative designers whilst highlighting important health issues – an excellent idea. The fashion show featured a collection of creations from a new wave of fashion designers that included Erwin Michalec, Sonia Funnell and Dee Naturals. Following the fashion show we delivered the awareness part of FASHION Meets AWARENESS  with a short presentation on cervical cancer covering what is cervical cancer, what causes it, risk factors, screening, the HPV vaccination and the symptoms.

This was a really fun event and we were very grateful to be given the opportunity to raise awareness of cervical cancer and we’d like to say a big thank you to Celena from Magnetic Fashion Connections for inviting us to take part in this event.