Fighting cancer - why the extension of screening programmes and a strong alcohol strategy could be key to success (Guest Blog)
06.02.23
Together, the expansion of screening programmes for prostate cancer and a stricter national alcohol strategy, could save many lives.
This was one of the main take-home messages of the 3rd Conference Living with Cancer after Cancer - European's Beating Cancer Plan Put in Practice. A forum of distinguished Slovenian medical experts, patients' advocates, National Institute for Public Health (NIPH) and Ministry of Health’s representatives took place on 26 January at Cankarjev dom, in Ljubljana, and was another in a series of a wide range of initiatives and measures related to the Europe's Beating Cancer Plan.
As Asst. Prof. Tit Albreht, MD, PhD, Head of the European program CraNE Joint Action, commented at the introduction, after many years of efforts, cancer has finally become a key public health priority and a health policy priority in the entire EU. "When we look back at the last two decades or more, one can feel nothing but pride in the path we have taken and the milestones we have achieved in regard to screening programmes, primary prevention and, above all, cancer treatment, but also the improvement of the accessibility to diagnostics and innovative methods of treatment. The Europe's Beating Cancer Plan imposes a series of measures on all member states in order to further improve cancer treatment, with a strong emphasis on the follow-up of patients and their returning back to life once their cancer treatment is completed."
Europe's Beating Cancer Plan consolidates numerous initiatives and measures striving to reduce cancer incidence in member states, improve early detection, diagnosis and treatment of cancer but also to improve the quality of life of patients and former cancer patients, said Tjaša Burnik, MA, Vice President of the board of the Forum of International Research & Development Pharmaceutical Companies in Slovenia: "In the fight against cancer, we are now focusing on "Sustainable cancer prevention". The fact is that up to 40 % of all cancers could be prevented, which is why one of the main objectives of Europe's Beating Cancer Plan is to raise awareness of the most important risk factors for cancer. It's important that we talk about it in order to develop methods and approaches on how to successfully address this issue."
Kristina Modic, President of ONKO NET (umbrella association of Slovene cancer patient organizations), highlighted the importance of cooperation among all stakeholders. "Patient organizations are an important stakeholder in ensuring modern treatment of cancer patients, while also advocating cancer prevention and early detection. The sooner the disease is detected, the less strenuous the treatment, the longer the survival and the better the quality of life are. Screening programmes, which are already very successful in our country, have certainly contributed a lot to successful prevention, so we are warmly welcoming the new ones in order to further improve cancer prevention."
On the brink of the extension of screening programmes to prostate cancerIn Slovenia, there has been a professional debate for some time about the possibility of introducing a new screening programme for prostate cancer, the most common cancer in men. Miha Pukl, MD, a urologist from Celje General Hospital, stressed that although too many men still die from this cancer, there is still a need for careful, expert evaluation of how best to introduce coordinated and strategic screening and the subsequent treatment pathways. "Currently, prostate cancer screening is done opportunistically, that is in an unorganized, random manner, and outside the recommended age span for screening. All that leads to overdiagnosis and is therefore harmful. The use of the PSA test was most widely spread from 1990s to 2009, consequently leading to a huge increase of prostate cancer incidence and numerous adverse effects.” Therefore, it is crucial to follow the new recommendations by the European Commission for properly managed screening enabling more men to have a much better survival.
Success of screening programmes strongly correlates with the awareness rate among the population. The main objective of raising awareness is the to achieve highest possible response rate to the screening programmes, where men clearly lag behind women. This is precisely why patient associations are working so hard to inform men on why it is so important to take place in screening programmes. "There are still many avoidable deaths and severe illness in men, and, unfortunately, also their response to screening programs is still worse than women. At OnkoMan, we are working hard to increase men's rate of response to screening programmes. We want to make screening as attractive to men as watching sports is to them," said Matej Pečovnik, President of the OnkoMan Association.
Slovenes are a "wet" nationThe focus of the second part of the debate was on risk factors for developing cancer and their prevention. Although excessive alcohol consumption very clearly and highly correlates with cancer, this fact is not generally talked about much in public. There is clear evidence proving links between harmful alcohol consumption and the occurrence of many cancers, among which gastrointestinal and head and neck cancers are the most common, but also breast cancer.
Alcohol affects many areas of our lives: mental health, maternal health, poisoning, injuries, traffic accidents, suicides, violence... and because of this, it has a very strong impact on the entire society, said Marko Kolšek, MD, PhD, from the Faculty of Medicine, University of Ljubljana. "It seems as if in Slovenia we are a society with an alcohol "culture" because alcohol is embedded in so many aspects of our lives. Although current recommendations put the acceptable drinking limit at 7 drinks per week for women and 14 for men, we must know that in reality the term safe drinking should not be used because there is no such thing. Drinking any unit of alcohol is in fact risky, only the range of this risk is different. We speak very little and reluctantly about drinking alcohol, but it would be good if we spoke more often and more loudly, especially when research shows that today even nine-year-old children can come in contact with alcohol."
An even more overlooked topic in the Slovene society is drinking among women. Data show that excessive alcohol consumption is present in as many as a third of adult Slovenian women. Asst. Prof. Simona Borštnar, MD, PhD, a medical oncologist from Ljubljana Oncological Institute, said that breast cancer is the most common cancer in women. "Every year 1,400 women get diagnosed and 400 of them die. Alcohol increases this risk even more. There are many risk factors for breast cancer that a woman has no control of, such as gender, age or family burden, but there are three that she definitely has. These are body weight, exercising and alcohol consumption. The harmful effect of excessive drinking has been proven by numerous epidemiological studies. Every year, 5 % or 70 female patients in our country get breast cancer due to excessive alcohol consumption."
Head and neck cancer is among the most common cancers, the occurrence of which is associated clearly with excessive alcohol drinking, said Ana Mihor, MD, a public health expert and young researcher from the Cancer Registry, and added that head and neck cancer "represents a group of cancers that account for five percent of all newly diagnosed cancers. It is the 7th most common cancer in men and the 15th most common in women, which means 470 new cancer cases and more than 200 deaths every year. The incidence is higher in the NE parts of Slovenia, known for its lesser sociocultural status. The main risk factor for this group of cancers is tobacco, followed closely by alcohol, with the worst being the synergistic effect of the two factors combined."
Since half of the cases of head and neck cancer occur in the oral cavity, dentists are extremely important in its early detection when treatment is significantly shorter, less exhausting and, above all, means a better quality of life for the patients, stressed Asst. Jana Krapež, PhD, a dentist from the Centre for Dental Diseases at Ljubljana University Medical Centre. "Dentists are most afraid of treating patients who have undergone radiation therapy because it is very harmful to teeth. Radiation of the tumour also destroys salivary glands that stop producing saliva. As a result, patients develop the so-called post-radiation rapid caries, which can cause necrotic decay of the jaw and teeth." She added that in the last two years, there had been a significant increase of late-detected head and neck cancer cases.
There is no such thing as a beneficial and safe alcohol drinkingThe conference ended with a round table where speakers were unanimous in their opinions that there is simply no safe limit for drinking alcohol. Mateja Kokalj Kokot, MD, a GP from the Association for Family Medicine, explained that "one unit of alcohol means exactly ten grams or, in other words, a small beer, a shot of brandy or 2.5 dcl of cider. When we talk about drinking, it is less risky if women drink seven and men drink 14 units per week, but we cannot emphasize enough that no amount of drinking is beneficial, and exceeding the limit poses a risk."
The speakers agreed that easy access to alcohol in Slovenia is a big part of the problem. What's more, the production of alcohol is also widespread among the people, with the production of spirits, wine and, in recent years, also beer, standing out in particular. As pointed out by Tit Albreht, tax policy alone will not ensure the decrease in production and consumption of alcohol, the reason more to raise awareness and actively implement preventive programmes.
Mojca Gobec, MD, from the Ministry of Health agreed we definitely need a more comprehensive alcohol strategy in Slovenia with all stakeholders involved. "Having such a strategy and policy is crucial for a better cancer control. It opens a new window of opportunity, as many adults are still unaware of the link between alcohol and cancer. It is likely that many people who are not addicted to alcohol, but drink it, would change their behaviour if they were more informed in this regard. It is similar to the case of sweetened beverages, where, despite the lack of a legal ban, there has been a massive drop in the consumption of soft drinks among young people. When awareness campaigns began to point out the fact that there were as many as 12 cubes of sugar in the most popular soda drinks, people began to look at it differently and gradually reduced its consumption. Low price of such drinks remains a big problem, as they are very affordable, even for people with a lower social status."
Tanja Španić, PhD, president of Europa Donna Slovenia, pointed out there were many expert discussions in patient organizations about the harmfulness of drinking alcohol and its connection with the development of cancer, also at the European level. Large cultural and religious differences are definitely noticeable there, strongly affecting the (un)acceptability of drinking alcoholic beverages. She noted that "not everywhere is alcohol perceived as negative as tobacco. We are not talking about this topic enough. We do not even ask women cancer patients whether they consume alcohol or not. However, we are striving for the reduction of the currently acceptable amount of alcohol consumption in the European Code against Cancer. We believe that in the new, refreshed Code this limit will be significantly lower."
