What we know
What information do we have about the Eastern Board area?
What is the result of this on our health locally?
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What is happening in the Eastern Board area?

Cancer is a term for a group of diseases in which abnormal cells start to develop in a part of the body. These abnormal malignant cells continue to grow and then spread (metastasize) through the blood stream and lymphatic system to other parts of the body such as the liver, bone or brain. This section looks at the prostate gland in males and the cervix in females. Cancer of the cervix or neck of the womb can be detected by a cervical smear test. This is done as part of the national cervical screening programme. Cancer of the prostate gland in males becomes more common with increasing age. There are calls for prostate cancer screening, but the current test gives too many false positive results. This means that people may undergo unnecessary treatment. Research continues for a more specific test.

The Northern Ireland Cancer Registry (NICR), based in Queen's University Belfast, collects information about cancer in Northern Ireland from a range of sources to get the best possible estimate of the number and type of cases of cancer in Northern Ireland. The NICR then provides information about the number of new cases of cancer each year (incidence) and the number of existing cases of cancer (prevalence) for all the different cancer types. The NICR now has data going back to 1993, which enables us to see the trends in cancer types over time.

Cancer is predominantly a disease of middle age and old age. According to data from the Northern Ireland Cancer Registry, half of all patients are aged 68 or over at the time of diagnosis. Females have a 1-in-8 chance and males a 1-in-6 chance, of dying of cancer by age 74. One in three people will develop some type of cancer during their lifetime, but the news is not all bad. With increasing research and new treatment, many types of cancer can be cured or at least halted for a time.

The Northern Ireland Cancer Registry reports that in 2001, cancer of the prostate gland was the third most common cancer in males in Northern Ireland, representing approximately 12% of male cancers registered. Half of the cases occurred in men aged over 74 years and few cases occurred under the age of 50. Prostate cancer was the second most common cause of cancer death in males.

The Northern Ireland Cancer Registry reports that in 2001, cancer of the cervix was the twelfth most common cancer in females in Northern Ireland, representing approximately 2% of all female cancers registered. Half of the cases were diagnosed in women below 48 years. Cervical cancer was the twentieth most common cause of cancer death in females.

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In 2005, there were 1591 deaths from all causes of cancer: 810 males and 781 females. Of these, 87 men died from cancer of the prostate gland. When we look back to 1991, the rate of death for cancer of the prostate has been decreasing for men. The rates fluctuate from year to year, because of the small numbers of deaths, but the trend is downwards. This could be due to fewer cases occurring, fewer cases diagnosed, earlier diagnosis leading to better treatment, or a combination of causes.

Cancer of the cervix accounted for 10 deaths in females in the Eastern Board area. When we look back to 1991, the rate of death for cancer of the cervix has been decreasing for women. The rates fluctuate from year to year, because of the small numbers of deaths, but the trend is downwards. Once again, this could be due to fewer cases occurring, fewer cases diagnosed, earlier diagnosis leading to better treatment, or a combination of causes.

Prostate cancer
There are a number of factors that increase the risk of prostate cancer. Unfortunately, most of these are factors that cannot be changed. For example:

	The risk of prostate cancer increases with age;
	Prostate cancer is more likely in those with a family history of the condition;
	The incidence of prostate cancer is higher in African Americans (about twice that of white men), and lowest in Asian and Oriental men.

Research has found that a diet high in animal fats and proteins and low levels of selenium may increase the risk of developing prostate cancer.

What about prostate cancer screening?
Screening is not a diagnostic test. Finding an abnormal result in screening may show that a person is at risk of a disease but further tests will be needed to make an accurate diagnosis. The natural history of prostate cancer is not fully understood. Prostate cancer is not a single disease but more a spectrum of diseases ranging from very aggressive to slow growing tumours, which may not cause any symptoms or shorten life. Over 90% of prostate cancer deaths occur in the 65 and over age group. By the age of 80 about 60-70% of men will have some cancer cells in their prostate. However only around 1 in 30 of these men will actually die of their prostate cancer.

PSA (Prostate Specific Antigen) is a substance made by the prostate gland, which naturally leaks out into the blood stream. A raised PSA can be an early indication of prostate cancer. However, other conditions that are not cancer (e.g. enlargement of the prostate, prostatitis, urinary infection) can also cause a rise in PSA. Approximately 2 out of 3 men with a raised PSA level will not have prostate cancer and the PSA test can also miss prostate cancer.

The National Screening Committee reviews the latest research evidence to advise the government about whether a screening test should be introduced, continued, amended or discontinued. The National Screening Committee currently advises that PSA testing should not be introduced as a screening test as it produces too many false positive and false negative tests. Men may then undergo unnecessary and inappropriate treatment for a disease that they do not have. Research into a more accurate method of testing is a priority and ongoing.

Cancer of the cervix
Cancer of the cervix is linked to sexual behaviour. The risk of developing cancer of the cervix is increased in:

	women who have had many sexual partners
	women who are carrying certain types of Human Papilloma Virus (HPV)
	women who smoke ( women who smoke are about twice as likely to develop cervical cancer as non-smokers)
	those who have had their first baby at a young age
	those who have had more than one pregnancy (the risk rises with the number of pregnancies)
	women in manual social classes compared with the risk in women from non-manual social classes

Using a condom gives some protection against cervical cancer while long-term use of oral contraceptives increases the risk. However, the benefits of taking oral contraceptives far outweigh the risks for the majority of women.

Cancer of the cervix or neck of the womb is usually detected by a cervical smear test. The woman undergoes an examination and some cells are taken from the neck of the womb and viewed under a microscope to see if there are any abnormal cells. Certain types of abnormal cells are an early warning that cancer may develop. Women with these abnormal cells require further examination to diagnose and treat any developing cancer.

Cervical cancer screening

In Northern Ireland all women between the ages of 20 and 64 are invited to attend every five years for a smear test. The best way for a woman to reduce the risk of cancer of the cervix is to ensure that she attends for this test when invited. For further details of the screening programme please refer to the cervical screening section of this website.

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