COMMENTARY

My Lifetime Risk for Cancer Is 1 in 2

David J. Kerr, CBE, MD, DSc, FRCP, FMedSci

Disclosures

April 06, 2015

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Hello. I am David Kerr, professor of cancer medicine at the University of Oxford, in the United Kingdom. As I have become a more senior member of the medical establishment, I have become involved in public health and have had a significant role advising governments from time to time.

A very interesting paper[1] has been published recently in the British Journal of Cancer, in which the authors estimated the lifetime risk of developing cancer of citizens in the United Kingdom. The authors are a very distinguished group from Queen Mary's University of London, England, so epidemiologically the study is very sound, using a strong evidentiary base; the national cancer statistics in the United Kingdom are quite good.

This group compared the lifetime risk of developing cancer for those born in 1930 with those born in 1960. They showed that for men, the risk has moved from 38.5% for men born in 1930 to 53.5% for men born in 1960. For women, the change is similar, with an increase from 36.7% for women born in 1930 to 47.5% for women born in 1960.

This means is that over one half of the people who are currently adults under age 65 years will be diagnosed with cancer at some point in their lifetimes. Let me say that again: Over one half of the people who are currently adults under age 65 years will be diagnosed with cancer at some point in their lifetimes. The lifetime risk for cancer is greater than 50%. One in two of us will develop cancer at some stage in our lives.

What Drives This Risk?

We are an aging population; thus, this increase in risk is driven in part by the demography of age. In women, the major increases have been in breast and lung cancer. In men, major increases are in prostate and bowel cancer. What are the reasons for this?

For lung cancer, smoking habits among women began to increase during World War II, and this trend has continued. For breast cancer, lifestyle changes have contributed, with women delaying having children, increasing obesity, and change in dietary habits. For prostate cancer, the increase is undoubtedly related to an ascertainment bias, with more use of prostate-specific antigen testing and earlier staging of prostate cancer. For colorectal cancer, one could argue that the increase has been driven by increased consumption of red meat and obesity.

What a remarkable statement: People of my generation have a 1 in 2 lifetime risk of developing cancer. This has huge implications for politicians, for charities, and for our health services. How can we respond to this ever increasing cancer burden? How do we make ourselves ready?

For me, most important is the message for citizens that the health service can do only so much to deal with the cancer once it has appeared, but we citizens need to take more responsibility for our own health. That means adopting lifestyle changes around diet and exercise—things we have discussed many times before.

The Macmillan cancer relief charity has just published data[2] showing that cancer survival rates in the United Kingdom continue to lag behind the other major European nations. Our cancer survival figures are about 20 years behind those in Scandinavia, Norway, Sweden, France, and The Netherlands. Here in the United Kingdom, we have this significant increase in incidence—a 1 in 2 lifetime chance of developing cancer—and yet our cancer services seem unable to deliver optimal cancer care.

This is quite a challenge for policy-makers, particularly for us within the United Kingdom. Right now, we are gearing up for a new general election, and our National Health Service (NHS) is always one of the hot political topics that the various political parties kick around. I have no doubt that, given these sorts of figures, cancer will be the top of their political health agendas.

I would be really interested in your comments, as always. For the time being, over and out.

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