Prevention 2003-2005

1. Prevention 2003-2005 David McLean MD, FRCPC Cancer Prevention Program BC Cancer Agency November 2003 BC Cancer Agency Prevention Program

2. The Context : The Cancer Control Strategy of BC and Canada • Prevention • Early diagnosis • Advanced treatment • Continuity of care • Research BC Cancer Agency Prevention Program

3. Why try to Prevent Cancer? • Probably at least 30 to 40% of cancer in BC is preventable by things we can control with today’s knowledge • It is the right thing to do • Focus: Tobacco, obesity/diet/exercise, sun BC Cancer Agency Prevention Program

4. Tobacco and Cancer Relative Risk Lung 20-30 X Bladder 5-6 Oral 4-5 Pharynx 4-5 Larynx 4-5 Esophagus 4-5 Pancreas 3-4 Kidney 2-3 Liver 2-3 Cervix 2-3 Myeloid leukemia 2-3

5. Obesity and Cancer (BMI > 25 kg/m2 vs <25 kg/m2) Increase in cancer due to obesity Colon 11% Breast 9% Endometrial 39% Esophageal 37% Kidney 25%

6. Cancer Prevention Program of BCCA • Professional Education • Preschool Sun Awareness Program • School “Better Choices” curriculum K-3 • Second Cancer Prevention Program • Surgical Morbidity Reduction Program • Population Awareness Program • Hereditary Cancer Program BC Cancer Agency Prevention Program

7. Professional Education • Physicians • Radiation Therapy Technicians • Dentists • Dental hygienists • Pharmacists • Others BC Cancer Agency Prevention Program

8. Professional Education - Skin Cancer • First course is a web-based course on skin cancer prevention and early diagnosis of skin cancer, in beta testing • All needed reading material on the web • Web-based exam, automatic marking • “certificate of special competence” issued on a plaque for waiting room BC Cancer Agency Prevention Program

9. Professional Education – Tobacco and Physicians • Partnership with the Society for Clinical Preventative Health Care, as of Oct’03- 265 Family Doctors registered for course • Course material on tobacco counseling, stop smoking techniques, etc. - web based • Recognition with a wall plaque for office • Expansion to remainder of BC family physicians and to specialists BC Cancer Agency Prevention Program

10. Preschool Sun Awareness Program • 4000 preschools in BC, April 2004 • in PHSA partnership with BC CDC • CD-ROM with 2 songs by Norman Foote • Slip, Slap, Slop, Cover Up • Block Out the Rays • Coloring sheets for May, June and July, with parental tips on safe sun behavior BC Cancer Agency Prevention Program

11. Preschool Sun Awareness Program • In development, a “New Preschool” Kit • CD ROM, songs by Norman Foote • Coloring material for students • Preschool sun safety suggestions, • Delivery by provincial government preschool inspectors BC Cancer Agency Prevention Program

12. BC School Program • Dr Lynne Baillie of the Interior Cancer Centre has developed a K-3 “Better Choices” program for schools - tobacco, exercise, diet, sun awareness, etc. • Being tested in Interior schools • To be made available to other school districts in partnership with the Rotary Clubs of BC

13. Second Cancer Prevention Program • Patients who have had one squamous cell cancer of the oral cavity are at very high risk for a second oral cancer if they continue smoking • We are developing a smoking cessation program that will target this small but very high risk patient population BC Cancer Agency Prevention Program

14. Surgical Morbidity Reduction Program • Compared to non-smokers, smokers have a much higher incidence of surgical complications, spend more time in intensive care, and have a higher in-hospital mortality rate. • Smoking cessation for two months is all that is needed to reduce immediate surgical risk • Working with the Health Authorities to target the 15-20,000 smoking patients on surgical wait-lists BC Cancer Agency Prevention Program

15. Population Awareness Program • In development, a website dedicated to evidence based cancer prevention information: www.preventcancer.ca • GOAL: Increased awareness of accurate cancer prevention information to permit educated lifestyle choices • In development, a teen website with tobacco information in a “teen relevant” format - for use as a school resource BC Cancer Agency Prevention Program

16. Hereditary Cancer Program • Probably 5% of cancer has a clearly single gene hereditary basis • also, as yet poorly defined, but probably very significant, polygenetic sensitivity to environmental effects (e.g. sun, tobacco, diet/obesity) BC Cancer Agency Prevention Program

17. Hereditary Cancer Program • Some Breast, Ovary • BRCA1 gene • BRCA2 gene • Some Colon cancer • Others BC Cancer Agency Prevention Program

18. Hereditary Cancer Program • Family history confirmation • Gene testing • Appropriate patient and family counseling BC Cancer Agency Prevention Program

19. Hereditary Cancer Program Potential Issues (among many): • Media driven demand, • New tests mean new costs, • Private pay testing means public pay interpretation and, often, more tests • Ensuring that health professionals are continually up-to-date in the face of rapid advances BC Cancer Agency Prevention Program

20. Community Partnerships & Policy Development • BCCA works with government, HA’s and partners such as the Cdn Cancer Society, Heart and Stroke Foundation, and BC Lung Assoc. to create a positive environment for healthy living, including tobacco control • e.g. we support proven methods: a 10% rise in tobacco price results is a 3-5% drop in consumption, 7% drop in teens BC Cancer Agency Prevention Program

21. Cancer Prevention Program of BCCA 2003-2005 • Professional Education • Preschool Sun Awareness Program • K-3 “ Better Choices” School Program • Second Cancer Prevention Program • Surgical Morbidity Reduction Program • Population Awareness Program • Hereditary Cancer Program BC Cancer Agency Prevention Program

22. Suggestions?Partnerships?dmclean@bccancer.bc.ca