Adapted from BMJ 16 March 2023

One in four deaths are due to cancer between the ages of 35 and 69. The most common 23 cancers were investigated by Shelton and colleagues. Even though we have an aging population, cancer deaths over the last 25 or more years have declined.

Data from adults in the UK, aged 35 to 69, who had a diagnosis or death from cancer were analysed retrospectively covering between 1993 and 2018.

The incidence of cancer registrations increased in both both sexes by a substantial amount. 57% increase for men and 48% for women. At the same time cancer mortality declined by 37% for men and 31% for women.

In men, the cancers with the best improved mortality were for stomach, bladder and mesothelioma with some improvement in prostate cancer. In women, the best improvements were for stomach, cervical and non-Hodgkin’s Lymphoma with some improvement for breast cancer. In both genders lung and bowel cancer improved considerably.

In the UK the chances of dying from cancer before the age of 80 declined between 2002 and 2019 from one in six to one in eight for women and from one in five to one in six for men.

The results have been due to a reduction in smoking, less asbestos exposure at work, earlier detection due to screening and health education, improved diagnostic investigations and improved treatments.

France, the Netherlands and Sweden also show declining cancer deaths in the same age group.

Some types of cancer, are however increasing, mainly due to the increased weight of the general population.

Some cancers have become more common. Liver cancer incidence has been rising since 1980. This is due to increased alcohol consumption and body weight. These two factors account for 4.1% of cancers in men and 6.3% in women.

In adults under 50 the incidence and mortality rates for bowel cancer are rising. Various hypotheses for this are increased weight, less physical activity and antibiotic effects on the gut microbiome.

Adapted from Breast Cancer Now 17.3.25

Breast Cancer Now, a research and support charity for breast cancer, sent a very helpful educational leaflet to all UK General Practitioners via Pulse, the GP magazine. Mainly, this is to act as a reminder to them, to investigate and refer women who could be presenting with breast cancer that has spread. Nowadays more than 4 in 5 women who are diagnosed with breast cancer survive long term. Women who present with secondary breast cancer symptoms can sometimes still be cured, but sometimes they can’t. Information about possible secondary cancer symptoms is useful for the GP, but it is even more useful for women who have had breast cancer, so I’m sharing it with you today.

Secondary breast cancer occurs when breast cancer cells spread from the first cancer to other parts of the body. This is via the lymphatic or blood system. General symptoms can be tiredness, nausea, loss of appetite and weight loss. These can be caused by many other conditions such as infections, medications, immunological disorders and other illnesses, but if you have previously had breast cancer it is worth getting a diagnosis sooner rather than later.

Signs that cancer may have spread to the bones include: bone pain that doesn’t respond to simple pain killers and may be worse lying down or at night. Fractures with or without prior trauma. Unexplained back pain, difficulty walking, numbness or lack of bladder or bowel control. Feeling sick or being sick, fatigue, passing a lot of urine, confusion, and being thirsty. These may be due to a high level of calcium in the blood.

Signs that cancer may have spread to the lungs include: feeling out of breath on activity that you usually can do easily, or breathlessness at rest. A cough that doesn’t go away after three weeks. Pain or tightness in the chest that doesn’t go away with rest.

Signs that cancer may have spread to the liver include: pain in the abdomen or the right shoulder. Pain under the ribs on the right side. Nausea, loss of appetite and weight loss. Persistent hiccups, swelling of the abdomen, feeling unwell or tired. Itching of the skin or yellow discolouration of the skin or whites of eyes.

Signs that cancer may have spread to the brain include: persistent headache, nausea and vomiting especially in the mornings. Weakness or numbness down one side of the body. Dizziness, unsteadiness, loss of balance or co-ordination. Fits. Difficulty with speech. Problems with vision. Changes in behaviour, mood or personality. Confusion. Memory problems.

Signs that cancer has spread to the skin include: a change in colour of the skin. A persistent rash. A firm, painless lump or nodules or multiple lumps of different sizes. Swelling of the arm, hand or breast area. Pain. Bleeding. Infection. Smell.

Signs that cancer has spread to the lymph nodes include: a lump or swelling under your arm, breast bone or collar bone. Swelling in your arm or hand. Pain. Dry cough.

Signs that cancer has spread to the abdomen include: abdominal pain, swollen belly, feeling sick all the time, loss of appetite, feeling full quickly when eating, constipation, feeling bloated.

If you have NEW symptoms, that DON’T HAVE AN OBVIOUS CAUSE, or DON’T GO AWAY, you must report these to a doctor. If you first see or speak to a nurse or physician assistant it is worth asking for a doctor appointment.

The charity Breast Cancer Now has a phone line where you can discuss your worries: 0808 800 6000. They have dedicated nurses and can tailor information and support to you, not just at the point that you are worried about symptoms but if you are then diagnosed with secondary breast cancer.

Adapted from BMJ 28 September 2024

British birth cohort studies have looked at the future health of only children compared to those from larger families. Those born in 1946, 1958 and 1970, who were only children, had no differences in the risk of heart problems, hypertension, high triglycerides, high glycated haemoglobin, or high C-reactive protein compared to those who had siblings, by the time they reached middle age.

However, the risk of cancer and poor general health was higher in those with three or more siblings.

My comment: Given my hunch that richer families tend to have fewer children, I sought further information from AI. There are strong links between health and socio-economic status, and the wealth of the parents, does tend to affect the wealth of the adult child.

The highest quintile socio-economically in European families, do tend to have the fewest children, having on average 1.5 to 2.0 children. Group 2 has 1.8-2.24. Group 3 has 2.0-2.55. Group 4 has 2.3 -2.7 and the lowest quintile has 2.5-3.0 children.

The number of children are affected by education and career aspirations, family planning access, and lifestyle factors.

I do think that researchers could have looked at the health of large sized families from wealthy families compared to poorer families to tease out how marked these differences were.

Adapted from BMJ 28 Sept 2024

When I was at school, in a class of 42 pupils, there were a handful of children who wore spectacles. I was one of them. It wasn’t uncommon, but it wasn’t a third of the class.

A global review has found that from 1990 to 2023 the overall prevalence of myopia (shortsightedness) in children and teenagers has more than tripled. It was 24% between 1990 to 2000, but now it is 36% from 2020 -2023.

The review of 276 worldwide studies predicts that this will reach around 40% by 2050.

Factors that increase the chances of becoming myopic are living in east Asia, living in urban areas, being female and having a high school education.

Being myopic doesn’t just affect your ability to see the blackboard, or figure out who is waving to you across the street, your night vision is also adversely affected.

Adapted from BMJ 12 Oct 2024

When vaping started out, it was seen as a heathier way to help people stop harmful cigarette smoking. In addition, the cost was dramatically less. Since then, it has attracted a new population, the never smokers.

Now about a million adults in England alone use vapes despite never having regularly smoked cigarettes. There are also worrying reports about children and adolescents using them.

Vaping rates in non-smokers were pretty stable from 2016 to 2020, with around one person in 200 smoking them. But after disposable vapes came on the market this has increased seven fold, and now 1 in 28 non-smoking adults use them regularly.

To start with, vapes seem to have no real downside, but increasingly, severe addiction and lung problems are seen to develop.