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Cancer and the fatalistic tendency

ARE Scots still too fatalistic about their health?

The latest cancer figurescontain some hopeful signs but the overall trend is going the wrong way. Both the number of new cases and the incidence of cancer are rising. Incidence is up by 3% in a decade and the number of cases diagnosed in 2011 was more than 30,000, a rise of 4000 over 2001.

On one level that is hardly surprising. As the population ages, so does the incidence of cancer. That is partly because many of those who would have succumbed to strokes, heart attacks and heart failure in their sixties are now living on into their seventies and eighties. So now two in five people in Scotland will be told at some point: "You have cancer."

Yet there is nothing inevitable about either the incidence of cancer or the mortality rate. For both figures the gap between Scotland and some other developed countries is still far too wide, even though survival rates have improved markedly. There are also telling variations within geographical regions and between different social groups.

More than 40% of UK cancers are caused by avoidable life choices, according to Cancer Research UK, with around a third linked to smoking, diet, alcohol and excess weight. In Scotland that equates to 10,000 cases a year. (A 20% rise in the incidence of lung cancer in women in the latest Scottish figures tells its own story.)

For governments this is a complex issue. Countless publicity campaigns about the benefits of exercise, healthy eating and limiting alcohol intake have not achieved the longed-for revolution in lifestyles. Rather, they appear to preach to the converted, while the intended targets defy logic and find ways of rationalising their bad habits.

The one area of real progress is on smoking, even though the benefits are not yet apparent in the statistics, which instead reflect historic trends. If there is a lesson, it is that a multi-level approach, combining intensive publicity with education and proscriptive legislation, is effectively stigmatising smoking. If diet, exercise and alcohol were tackled with the same seriousness, could a similar momentum be achieved in favour of more generally healthy lifestyles? Glasgow 2014 is a little more than a year away. Where is a massive push to get active that accompanied London 2012?

If lifestyle is one issue in Scotland's cancer statistics, the other is early diagnosis. There has been progress, especially in breast cancer, where the increases in both incidence and survival are partly due to increased detection. But in other cancers late diagnosis remains a major issue, despite the Government's Detect Cancer Early initiative. Here is another area requiring a multi-pronged strategy: increased screening, especially for high-risk groups; quicker access to diagnostic tests; improving the reliability of data; educating GPs to spot the warning signs and convincing patients (especially men and those on low incomes) not to shrug off minor symptoms and regard their health as the luck of the draw.

Contextual targeting label: 
Health

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