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While there are positive signs and progress on many fronts, it is clear that Australia is not healthy in every way, and there are some concerning patterns and trends. The rise in the proportion of Australians who are overweight or obese has occurred across virtually all ages. There is a relationship between socioeconomic status and obesity: people who live in the most disadvantaged areas are more likely to be obese than people in less disadvantaged areas. National surveys show that the proportion of the population with diabetes more than doubled in Australia between 1989–90 and 2007–08. After adjusting for age differences, Aboriginal and Torres Strait Islander people were more than 3 times as likely as non-Indigenous Australians to report some form of diabetes. The prevalence of anxiety and affective disorders was highest for people aged 35–44, and more common among females. Sexually transmissible infections (STIs) are diseases that are spread through sexual contact.
In 2011, there were about 80,800 chlamydia infections reported in Australia—a sixfold increase since notifications began in 1994. Notifications have increased for both males and females, although there were about 40% more notifications for females. End-stage kidney disease (ESKD) occurs when chronic kidney disease has advanced to the stage where the person’s only chance of survival is dialysis, or a kidney transplant.
The total incidence rate of ESKD is 6 times as high among Aboriginal and Torres Strait Islander people as it is among non-Indigenous Australians, and Indigenous people are 8 times as likely to begin dialysis or receive a kidney transplant. Australians living today experience relatively good oral health compared with those in the past. Higher income groups were also less likely to experience complete tooth loss, toothache and food avoidance, and to report discomfort with their appearance. National surveys show that vision and hearing disorders are some of the most common long-term conditions among Australians.
Vision and hearing disorders are often linked to age, with older people more likely to be affected than younger people.
Blood, organs and tissues can be donated to improve quality of life, and life expectancy, of people with a range of health conditions. While donor and transplant numbers are gradually increasing over time, the number of people on the transplant waiting list continues to exceed the number of available organs.
The rate of organ and tissue donation in Australia is also considered low by international standards.
The amount of time it takes for a patient to see a health professional is important for the patient, the relevant health service, and governments. For elective surgery, the measure used in Australia is the median waiting time, that is, the middle value in the data arranged from lowest to highest number of days waited. For emergency department care in 2010–11, 70% of patients were seen within the recommended time for their triage category. Many aspects of health are related to how well-off people are financially: generally, with increasing social disadvantage comes less healthy lifestyles and poorer health. An example of a health behaviour with a strong relationship to socioeconomic status is tobacco smoking. One interesting exception to this pattern of less healthy lifestyle with lower socioeconomic status is risky or high-risk alcohol use, which shows no particular pattern.
The government has launched a healthy living campaign in a bid to stem rising obesity rates in England. It includes television adverts warning too much body fat leads to cancer, type 2 diabetes and heart disease. Ministers warned that, if left alone, obese and overweight people would cost the taxpayer in England ?50bn by 2050.
Tesco, Kellogg's and Unilever are among the companies who will be promoting the "eat well, move more, live longer" message in the "Change4Life" strategy. The three-year initiative follows a Foresight report, published last year, which warned the government must act to stop Britain "sleepwalking" into a crisis. The report, which was the largest UK study into obesity, backed by the government and compiled by 250 experts, said excess weight had become the norm in our "obesogenic" society. She added that the extent of the obesity problem demands an "ambitious and innovative" approach that has not been tried before. The television adverts, which will run for three months, were put together by Aardman Animations, the people behind Wallace and Gromit, and are designed to appeal to families. The Change4Life initiative branding will also be used by charities, local organisations and companies. Unilever, the company behind Flora, will use the logo in its sponsorship of the London Marathon.
Dr Susan Jebb, head of nutrition and research at the Medical Research Council and government advisor on the campaign, said in the modern world it was "utterly astonishing" that anyone stayed slim.
Chief Medical Officer Sir Liam Donaldson said only 6% of people understood the health risks of being overweight.
A recent report from the King's Fund urged the government to be more innovative in tackling healthy behaviour. Report author Dr Tammy Boyce said the Change4Life programme showed the Department of Health was willing to embrace new methods to influence behaviour. Tam Fry, of the National Obesity Forum, said the enthusiasm behind the campaign was welcome. However, he said he had reservations about whether there would be enough funding in place to match the might of industry.
He said he was concerned the food and advertising industry was using partnership with government as a way of fending off the threat of legislation. At National Pain Institute (with locations in Florida) we have the experience to properly diagnose diabetes and to treat diabetes-related acute and chronic pain without using addictive pain medications or invasive surgery.
Diabetes is also called “diabetes mellitus.” It is a group of diseases that occur when too much sugar is in the blood, which is also referred to as high blood glucose. It is important to note that many people who suffer from Type 2 diabetes have mild symptoms that oftentimes go unnoticed and become ignored. Diabetes treatment and care heavily depends on the type of diabetes you’ve been diagnosed with.
Various treatments and care options exist to help with diabetes symptoms and the symptoms that arise from diabetes complications. National Pain Institute helps you manage and treat diabetes-related symptoms and pain in a conservative way. There are many different lifestyle strategies you can use to manage and live with diabetes on a daily basis. One major strategy to implement, regardless of which type of diabetes you have, is to eat a balanced diet. Another strategy to implement, regardless of the type of diabetes you have, is to implement a routine exercise regiment. If you have any questions, please do not hesitate to call our doctors at National Pain Institute. If you are struggling with symptoms of diabetes and have not yet been diagnosed, call National Pain Institute. If you have been diagnosed with diabetes and suffer from acute or chronic pain associated with diabetes, call National Pain Institute. National Pain Institute has several office locations in Florida: Deerfield Beach, Delray Beach, Ft. We look forward to successfully treating your diabetes-related acute and chronic pain in a minimally invasive way. The interdisciplinary treatment approach is recognized as the most effective method for pain management according to the American Academy of Pain Management and the American Board of Pain Medicine.
At an advanced stage, a malignancy will often cause severe weight loss and wasting (cachexia) which in itself can be sufficient to cause death, but often the affected person develops a chest infection (such as bronchopneumonia) which is the direct cause of death. Non-malignant (non-cancerous) abnormal growths are the result of unregulated cell growth, but do not invade locally or metastasize.
Cancers can thus have a variety of effects on the body because of these characteristics and because there are some 200 different types. It is generally thought that, in most instances, at least two factors are needed for a cancer to develop: (i) a genetic predisposition for that type of cancer, and (ii) a specific trigger factor. This is summed up in the phrase “Genetics loads the gun but it is lifestyle that pulls the trigger” variously ascribed to Elliott Joslin speaking in the 1920s and to Francis Collins. Cancer has been much feared and is often placed in a higher status than other equally (or more often) fatal conditions, such as heart attack, heart failure, kidney failure.
It is perhaps also noteworthy that, generally, whilst deaths from cancers overall are falling, the incidence of cancer is rising, predominantly due to the fact that fewer people are now dying from heart attacks and strokes than before, and living longer.
According to Public Health England, premature deaths in Enfield (that is, under the age of 75 years) are below the national average for cancers overall and for those cancers that are considered to be preventable. The pie charts below present the proportion of cancer death from lung, prostate, colorectal, and all other cancers amongst men in Enfield and nationally. The number of people dying from cancer in Enfield is much smaller and thus subject to much greater year-to-year variation. There are no great differences in the pattern here: the number of people dying from cancer in Enfield is much smaller and thus subject to much greater year-to-year variation. The graphs above show that both men and women have seen year-on-year variations in mortality rate for lung, colorectal, breast and prostate cancer over the past few years, mostly owing to the small numbers involved.
As seen in the graph on the proportion of cancers attributable to different lifestyle exposures, tobacco smoking is by far the most important risk factor for cancer in the UK, responsible for 60,000 cases (19.4% of all new cancer cases) in 2010 (Parkin et al, 2011).
The graph below shows that in a 20-year period from the middle of the last century, at a population level, women increased their consumption of cigarettes at a high rate whilst at the same time men kept their consumption much the same. There is still a large gap in incidence and mortality from lung cancer between men and women, with the male rate almost double.
Unless we expend greater effort in (i) enabling, especially, women who smoke to give up, and (ii) enabling young girls who do not yet smoke never to start, there will be an increasing health burden in women due to the plethora of diseases caused by smoking, including cancers.
The most important point is that a high proportion of cancers are avoidable through healthier lifestyles. Note: Non-Melanoma skin cancers are not included in general cancer mortality or incidence statistics, despite being a very common form of cancer. As the graph above shows, Enfield had a significantly lower mortality rate than England, and a lower rate than London.
Between 2010 and 2012, Enfield’s reported cancer incidence ratio (new cases) was 91.8, which was around 8% lower than expected. The most commonly diagnosed types of cancers (excluding skin non-melanomas) in England are lung, breast, prostate, and colorectal cancers, which account for 53% of new cancer diagnoses nationally (Cancer Research UK – Cancer Diagnosis Statistics). Breast cancer is the most common cancer in women and accounts for about one third of cancers in women (see pie charts below). Recent draft guidance from the National Institute for Health and Care Excellence (NICE) on some women with a significant family history of breast cancer indicates that this risk can be reduced by taking certain drugs (NICE, 2013). Compared to White women, most other ethnic groups have much lower incidence rates for breast cancer (see graph below), although there is evidence emerging that Asian women who permanently move to a western country increase their risk of breast cancer, and that the rate in South Asian women may be increasing above that of White women (University of Sheffield, 2013). In the three years 2011-13, an average of 197 women (of all ages) in Enfield were diagnosed with breast cancer each year. The incidence in Enfield is very similar to the overall rates in both England and London and although the death rate appears to be slightly higher than London and England averages, this is not statistically significant (see graphs below). In 2014, 74% of the women in Enfield invited for breast screening in the preceding 36 months attended, which is similar to the coverage for England overall and higher than the coverage for London. For every thousand women screened, about 40 will require further investigation because of a potentially abnormal mammogram. Women of all ages are also encouraged to be ‘breast aware’ and to examine their own breasts regularly so that they will identify any lump or abnormality as soon as it appears and seek their doctor’s advice urgently if they find something. The incidence of breast cancer has risen only very slightly over the past years and therefore the need for treatment is unlikely to change substantially in the next few years. Breast cancer may be treated by surgery, radiotherapy, chemotherapy or a combination of these depending on the type of cancer and its stage (how far it has spread). The National Institute for Health and Care Excellence (NICE), which produces evidence on best practice for treatment of different diseases, has set quality standards for the treatment of breast cancer. Management of breast cancer is a standard component of health and social care commissioning and is unlikely to have any unexpected impacts on other areas. Currently service providers are compliant with access and treatment targets and there is no reason to suspect that there are any significant service gaps.


Commissioners should ensure that health and social care services (as appropriate) are encouraging women eligible for screening to take advantage of the opportunity to be screened. Lung cancer starts in the lung or airways (bronchi and trachea) but may spread to involve lymph nodes and other structures in or near the chest.
There are two main types of lung cancer; small cell and non-small cell, which behave differently and have different outcomes according to their subtype and staging at diagnosis. Lung cancer is the most common cause of cancer death in men and women (see charts above: ‘causes of cancer deaths’). When a smoker quits smoking their risk of lung cancer falls (although it does not return to the level of risk of someone who has never smoked). Death rates from lung cancer are also substantially higher in those living in more deprived areas, with those living in the most deprived areas experiencing a rate more than double those living in the least deprived areas (Romeri et al, 2006). Most people from Black, Asian and minority ethnic groups have a lower incidence of lung cancer than White groups, principally because of smoking habits. As shown in the chart below, in 2014, Enfield had a lower proportion of current smokers (13.6%) than both London (17%) and England (18%). Patients with lung cancer may be treated with surgery, radiotherapy, chemotherapy or a combination of these treatments depending on the type and stage of their cancer. Because fewer men smoke now, the incidence and death rate from lung cancer in men is decreasing. Currently, about 30% of patients with lung cancer survive one year after diagnosis and about 10% five years (see below).
The National Institute for Health and Clinical Excellence (NICE), which produces guidance on best practice for treating various conditions, has published detailed guidance on the diagnosis and treatment of lung cancer (CG121). Currently service providers are compliant with access and treatment targets and there is no reason to suspect that there are any significant gaps. Current national campaigns focus on possible signs and symptoms of lung cancer, and local commissioners should consider linking in the national campaign to promote this message locally. Commissioners should ensure that appropriate health and social care services encourage people who have had a cough lasting more than three weeks to visit their doctor: it can be a symptom of lung cancer. In Enfield, around 23.4% of people with lung cancer died at home in 2011-13, compared to 32% across England.
Providers of treatment should work with researchers when the opportunity arises to continue their efforts to support the development of more effective treatments for lung cancer, and commissioners should support this. Colorectal cancer is the fourth commonest cancer and accounts for about one in eight cancers (see chart on cancer incidence in the general introduction). Bowel cancer shows very little difference in incidence (new cases) between levels of deprivation. Note: In this graph, and the following three graphs, vertical bars have been used to indicate 95% confidence intervals. Compared to people in White ethnic groups in the UK most other ethnic groups have a much lower incidence rate for bowel cancer (see graph below). In the years 2010-12, an average of 76 men and 72 women in Enfield developed bowel cancer each year. Between 2010 and 2012 in Enfield the rate of colorectal cancer incidence amongst people aged under 75 years was 68.43 per 100,000 population, lower than the England average but slightly higher than the London average. Early detection of bowel cancer is important: if treated when it is at a very early stage it is curable in more than 90% of instances. Another method to define stages of Bowel cancer is the Dukes’ staging method which ranges from A to D: Dukes’ A stage cancer is limited to the lining of the bowel itself, whilst, at the other extreme, Dukes’ D stage cancer has spread to other organs such as the liver.
With an over-90% ‘cure’ rate of colorectal cancer if diagnosed at the earliest stage, it is vital that people are encouraged and enabled to take advantage of bowel cancer screening. The World Health Organization predicts there will be 2.3 billion overweight adults in the world by 2015 and more than 700 million of them will be obese.
The increase of convenience foods, labour-saving devices, motorised transport and more sedentary jobs means people are getting fatter. The body mass index (BMI) is the most commonly-used way of classifying overweight and obesity in adult populations and individuals. Each BMI figure is classified within a range, eg 18-25 is ideal and over 30 is reckoned to be obese.
According to a survey of bodyshapes conducted in the UK in 1951, a woman's average waist size was 70cm (27.5in). There was no comparative data for men in 1951, but the SizeUK survey showed the average man in 2004 had a waist of 94cm (37in) and a BMI of 25.2, technically just outside the ideal range.
But obesity is not just a problem for adults - the spread of obesity among children is also alarming experts. At least 20 million children under the age of 5 years were overweight globally in 2005, according to the WHO. Measuring children, aged 5 to 14 years, who are overweight or obese is challenging because there is not a standard definition of childhood obesity applied worldwide.
Experts are worried that the increase in obesity will lead to more health problems as people who are overweight have a higher risk of heart disease, Type II diabetes and other diseases including some cancers. As most data sources do not distinguish between Type I and II diabetes in adults, it is not possible to present the data separately.
Even if the prevalence of obesity remains stable until 2030, the American Diabetes Association, says that the number of people with diabetes will more than double. It says the increase may be "considerably higher" than this if, as expected, the prevalence of obesity continues to rise around the world. Results from the 1999-2002 National Health and Nutrition Examination Survey (NHANES), using measured heights and weights, indicate that an estimated 16 percent of children and adolescents ages 6-19 years are overweight.
To assess changes in overweight that have occurred, prevalence estimates for participants in the 1999-2002 NHANES were compared with estimates for those who participated in earlier surveys. When the overweight definition (greater than or equal to 95th percentile of the age- and sex-specific BMI) is applied to data from earlier national health examination surveys, it is apparent that overweight in children and adolescents was relatively stable from the 1960s to 1980 (table 1). 2 Data for 1963-65 are for children 6-11 years of age; data for 1966-70 are for adolescents 12-17 years of age, not 12-19 years.
These areas pose a challenge to our health system and suggest that there is premature death and disease that might otherwise be avoided. Comparisons among other developed countries show that Australia has the second highest rate of obesity for males and the fifth highest for females. In 2007–08, 1 in 4 adults and 1 in 12 children were obese; this equates to almost 3 million people. It is caused either by the inability to produce insulin (a hormone produced by the pancreas to control blood glucose levels), or by the body not being able to use insulin effectively, or both.
The latest estimates suggest that 898,800 people (4.1% of the population) have been diagnosed with diabetes at some time in their lives. A 2007 survey showed that 1 in 5 Australians had experienced a mental disorder in the previous 12 months.
The prevalence of substance use disorders was highest for people aged 16–24, and more common among males. Diagnosis can be difficult as many STIs have no symptoms or have symptoms that are mild, despite serious complications that may develop later. It affects 1 in 7 Australian adults to some degree and is often considered preventable because many of its risk factors (such as smoking and excess body weight) are modifiable. At the end of 2009, about 18,300 people in Australia were receiving regular dialysis treatment or had a functioning kidney transplant—more than a sevenfold increase since 1977.
In 2007–08, 52% had a long-term vision disorder (such as long- and short-sightedness) and 13% had a long-term hearing disorder (such as complete or partial deafness). Hence the number of people affected is expected to increase as the Australian population ages.
A survey in 2009 found that 60% of people making a GP appointment for a matter they felt required urgent medical care were seen within 4 hours of making their appointment. In 2010–11, the median waiting time was 36 days (meaning that 50% of patients had received their surgery within 36 days). In 2010, 25% of people living in the most disadvantaged areas smoked tobacco, twice the rate of people living in the least disadvantaged areas.
The Co-op, National Convenience Stores and Tesco will have the branding in its shops and PepsiCo UK will run an advertising campaign to promote "active play" through sports personalities. Report any symptoms to the doctor so that he or she can make a proper diagnosis and develop a customized treatment plan for you.
If early detection and treatment is not achieved, diabetes complications can arise, which may not be pleasant.
For those suffering from Type 2 Diabetes, oral medications and a heathy lifestyle can usually keep blood glucose levels at a healthy rate. When this happens, the patient will need to use insulin to maintain healthy blood glucose levels.
Once we perform an evaluation and speak with you regarding symptoms you’re experiencing, we will determine which treatment options will provide the most benefits.
Your doctor will discuss dietary restrictions and certain foods that you should eat in order to manage diabetes.
We will help you manage the diabetes-related pain and symptoms using a conservative approach, which includes non-addictive medicine while avoiding surgery as much as possible.
NPI offers individualized, state-of-the-art programs by knowledgeable, board certified or board eligible physicians for the management of acute, chronic or intractable pain. Pierce, FL Lake Mary, FL Longwood, FLNew Port Richey, FLOcala, FLOconee, FLOrlando, FLPort St. Individuals with a particular medical condition are encouraged to seek the advice of a competent medical professional who can fully address their specific, unique needs. Each type of cancer can behave in different ways in terms of their rate of development locally and rate and site of metastasis. For example, the majority of lung cancers are associated with smoking, but not all smokers develop lung cancer. A recent high profile study concluded that avoidable extrinsic risk factors contribute more than 70 to 90% to the development of common cancers (Wu et al, 2015). Perhaps this should no longer be the case as most cancers are now treatable to a much greater extent than before and it is becoming increasingly common for people to die with cancer rather than from it: perhaps soon many types of cancer will be regarded as long-term conditions. Whilst this is encouraging, there is still much that can be done to reduce the burden of cancer amongst Enfield residents further.
The proportion of cancer deaths due to lung cancer in Enfield (30%) was higher than that of the England average (22%).
For men, mortality rate for prostate cancer has fallen sharply and is now below that of colorectal cancer. Subsequently, at a population level, men reduced the number of cigarettes they smoked at a much faster rate than women.
However, the trends of lung cancer may start to change as the differences in smoking rates between men and women in the last few decades begins to have an impact. For example, research has shown that people who have smoked for 45 years have 100 times the lung cancer risk of those who have smoked for 15 years, regardless of whether they smoked heavily or moderately (Doll and Peto, 1978).
This is because non-melanomas are easily treatable, so are often managed by GPs or outpatient services. Alcohol, obesity, certain occupations and low physical activity are known to be major risk factors for breast cancer, and breastfeeding lowers the risk (Parkin et al, 2011).
The incidence of breast cancer is higher amongst women living in more affluent areas, as shown in the graph below. There is evidence to show that exercise reduces the risk of breast cancer (Cancer Research UK – Breast Cancer – Causes). Where the confidence intervals (shown as vertical lines) do not overlap we can be ‘95% sure’ that there is a statistically significant difference between such groups of people, that is, the difference is due to a real factor and is not due to chance. Enfield’s rate of breast cancer incidence for women of all ages between 2011 and 2013 was 149.4 per 100,000 women (HSCIC).
For breast cancer detected at the earliest stage (Stage 1) when the cancer is small and has not spread the outlook is excellent (Cancer Research UK – Breast Cancer – Outlook). Women between the ages of 50 and 70 are invited for screening every three years which allows most breast cancers to be detected at an early stage. The graph below shows that while the England rate has been declining slightly and London has remained largely stable, Enfield’s rate has substantially increased from 67% to 74% in the past 5 years. Of these, about eight will have a cancer of which about three will be invasive and large (more than 15 mm in diameter); a further three will be invasive but small, and about two will be non-invasive. However the death rate has fallen by nearly 40% over the past 30 years, possibly due to screening and more effective treatment.


Results have improved dramatically over the years and now eight out of ten women with breast cancer will survive for ten years or more.
However, it is important to note that early presentation is important and thus service commissioners should ensure that health and social care providers encourage and enable women to take opportunities for breast cancer screening and consult their GP if they have any symptoms or concerns about their breasts.
Lung cancer can also spread and produce secondary tumours (metastases) in brain, bone and other organs.
The proportion of cancer deaths due to lung cancer for women in Enfield is similar to the overall picture for England. More than eight out of ten people who develop lung cancer do so because they smoke tobacco or because they are exposed to the tobacco smoke of others.
Research has shown that the risk of dying from lung cancer in heavy smokers is 25 times greater than that of lifelong non-smokers (see graph below). For lung cancer the fact that older people were more likely than younger people to have been smokers in the past contributes to their higher death rates because their general health is usually much poorer. This is in part due to higher smoking rates in these areas but also because deprivation contributes independently to an increased risk of lung cancer and to poorer health at an earlier age.
A notable exception to this is Bangladeshi men, who traditionally have very high smoking rates. Incidence rates in Enfield are not significantly different from those in London or England. Incidence rates and death rates are similar since the majority of people with lung cancer do not survive long after the diagnosis is made. However the incidence and death rates in women have changed little because, at a population level, their smoking rates started to fall later and at a slower rate. This is not always possible, but good support should allow more people with lung cancer to die at home. To enable more patients with lung cancer to die in a place other than an acute hospital, commissioners should consider the need for better palliative care provision such as additional hospice-type accommodation and increased home support for carers and families of patients. Incidence is slightly higher in men who live in more deprived areas but not in women (see below). It is not entirely clear why this is but may be related to diet and other lifestyle habits. There are two ways to define the stage of bowel cancer – the most common method is TNM, and the table below outlines 5 year survival rate based on stage at diagnosis. People are asked to smear a little of their stool on to a specially-treated piece of card and post it back to a laboratory for testing. Whilst the process required is perhaps slightly distasteful, it is little more so than cleaning yourself after opening your bowels – something most people do just about every day. A 3-D survey carried out by SizeUK in 2004 found the average woman had a waist measurement of 86cm (34in) and a BMI of 24.4, just inside the ideal range.
As shown in Table 1, this represents a 45 percent increase from the overweight estimates of 11 percent obtained from NHANES III (1988-94). The NHANES 1999-2002 and earlier surveys used a stratified, multistage, probability sample of the civilian noninstitutionalized U.S.
However, from NHANES II (1976-80) to NHANES III, the prevalence of overweight nearly doubled among children and adolescents. Many experts are concerned about the effect rising obesity may have on our rates of diabetes, heart disease and other disorders, perhaps even on our life expectancy. Type 1 diabetes results from the body’s own immune system damaging the pancreas so it can’t produce insulin, and the condition is not preventable.
Overall, the most common types were anxiety disorders (14%), affective (mood) disorders (6%) and substance use disorders (5%).
The rate of new cases of treated ESKD is projected to increase by 80% between 2009 and 2020. When the adult population is divided into thirds by household income (adjusted for the size of the household), oral health improves as we move from the lowest income group to middle and highest incomes.
The majority (85%) of injuries were unintentional —they were not caused deliberately—however, many could have been prevented. For those aged 65 and over, females are more likely to be hospitalised, due mainly to falls.
We do, however, know that genetics and other unknown factors are common causes of Type 1 Diabetes. And since there is no cure for diabetes, proper diabetes management becomes extremely important.
A healthy weight, exercising, taking medications as prescribed by your doctor, and eating the right foods will help to maintain proper and healthy blood glucose levels. As such, cancer can be seen as not one disease, but an umbrella term for a wide variety of different ones. A smoker who has a genetic predisposition to develop lung cancer is very likely to do so (although they may die of something else before it becomes symptomatic or is diagnosed) and a smoker without that genetic predisposition is less likely to develop lung cancer (although they are still likely to die of another smoking-related disease). Moreover, four lifestyle choices constitute up to one third of total cancer risk, as depicted in the graph below (Parkin et al, 2011).
Increasing survival rates for cancer are due both to people being fitter and healthier than they were 30, 50 and 100+ years ago and to improvements in various cancer treatments.
On the other hand, the proportion of cancer deaths due to prostate cancer in Enfield (9%) was below that of England (13%). Between 2011 and 2013, there were a total of 787 deaths amongst under 75 year olds which were recorded as being caused by cancer. As such, cases are often not reported centrally as data is generally extracted from hospital records.
Cancer mortality varies across Enfield, with ward level data showing significant variation.
It can spread (metastasise) to lymph nodes in the armpit, to the chest, bones, brain and other parts of the body. The rates of diagnosis amongst women aged between 50 and 70 years old are further increased by routine screening as more cancers are detected earlier (and can therefore be treated sooner). This gap has not changed between1996 and 2010 and it is estimated that there would have been around 1,900 more cases of breast cancer each year in England if the rates of the most deprived were the same as the least deprived.
There are plans to extend screening further to the age groups 47-50 and 70-73 years by 2016. There is some controversy as to whether breast screening results in unnecessary surgery and whether it really saves lives, but most evidence suggests that it is beneficial (NHS Breast screening programme Annual Review 2012) and unless other significant evidence emerges, women should continue to be encouraged to take up the opportunity of breast screening. This is usually expressed as the percentage surviving one year, five years and ten years after diagnosis. Women should also be encouraged to be breast aware, to notice any changes in their breasts and consult their GP if they find any lumps or abnormalities.
However, a higher proportion of cancer deaths for men in 2013 were from lung cancer in Enfield compared to England. An enormous number of other studies have found similar effects: it is unequivocal that smoking – which is a lifestyle choice – is the major cause of lung cancer (among a large number of other fatal and non-fatal diseases). The graph below, which uses data from the South East Cancer Registry, shows that men from different ethnic groups generally have lower incidence rate ratios than White men (for whom the incidence rate ratio has been set as one). The graph above shows that the proportion of people dying from lung cancer in Enfield who die at home is similar to that in England and London generally.
There are some differences between the behaviour of these two cancers but they have much in common and are usually thought of as a single disease. Usually bowel cancer starts as a polyp (a mushroom like growth) on the lining of the bowel which then grows to involve the wall of the bowel and then other structures in the abdomen.
It is noteworthy that this is not the case in, for example, the USA, where African Americans are more likely to develop colorectal cancer than any other ethnic group there. The death rate from bowel cancer is slightly higher than in London and England, but not statistically significantly so. Nationally, about half of those invited (50% of men and 54% of women) accept screening, but the proportions in London are lower (37% of men and 43% of women), although the proportion accepting screening (51%) is higher in Enfield than in several neighbouring boroughs.
Based on current recommendations of expert committees, children with BMI values at or above the 95th percentile of the sex-specific BMI growth charts are categorized as overweight.
In the time interval between NHANES II and III, the prevalence of overweight among children ages 6-11 years increased from an estimated 7 percent to 11 percent (figure 1), and among adolescents ages 12-19 years, increased from 5 percent to 11 percent. For example, 87% of people in the highest income group rate their oral health as good, very good or excellent, compared with 84% in the middle income group and 73% in the lowest income group. Falls and transportation (mostly motor vehicles) were common external causes of injury (49% of all hospitalised cases). A number of wards, including Palmers Green, Bowes, Southgate, Bush Hill Park and Cockfosters had mortality rates significantly lower than would be expected based on the England rate, whereas Chase and Enfield Lock had rates significantly higher. Before the age of 50, breast cancer is uncommon, and the evidence of benefit from screening after the age of 73 years is currently uncertain. One-year survival is considerably affected by how early the condition is detected and treated, whilst five- and ten-year survival rates are more reflections on the effectiveness of the treatment itself in those who survive at least one year. It is also important to recognise that the risk of developing lung cancer is not confined to smoking cigarettes but to smoking (or inhaling second-hand smoke) from all tobacco products. Women from different ethnic groups show a similar pattern and often have lower rates than men in their own ethnic group as they tend to smoke less (but are exposed to the second-hand smoke of others). In the more distant future, lung cancer rates in women will also start to fall as they begin to benefit from lower smoking rates, but it will remain a significant problem for a long time to come and is likely to take over from breast cancer as the most common cause of cancer death in women. In Enfield in the years between 2011 and 2013, 32 men and 29 women died of bowel cancer on average each year (HSCIC). Women were more likely than men to accept screening and people living in the least deprived areas more likely to do so than those in the most deprived ones. A household interview and a physical examination were conducted for each survey participant. One of the national health objectives for 2010 is to reduce the prevalence of overweight from the NHANES III baseline of 11 percent. Type 2 diabetes—which accounts for 85–90% of all cases—is linked with lifestyle factors such as obesity, physical inactivity and unhealthy diet. There were about 25,700 hospitalisations where the injury was self-inflicted and about 23,000 where it was inflicted by another person. The situation with the use of oral contraceptives and with post-menopausal hormone replacement therapy is more complex.
It is also noteworthy that shisha smoking exposes the smoker to far greater quantities of tobacco smoke and toxins than smoking cigarettes (Center for Disease Control, 2013).
There may be other factors at play in the different incidence rates of lung cancer in people from different ethnic groups, including genetic ones, but the overriding factor is smoking tobacco. The risk can be decreased by having more fibre in the diet and, separately, by being sufficiently physically active. During the physical examination, conducted in mobile examination centers, height and weight were measured as part of a more comprehensive set of body measurements. However, the NHANES 1999-2002 overweight estimates suggest that since 1994, overweight in youths has not leveled off or decreased, and is increasing to even higher levels. There may be a slightly increased risk of breast cancer associated with such treatments but it seems to reduce a few years after these are stopped. Smoking is not necessarily a risk factor for colorectal cancer but a smoker who develops colorectal cancer is more likely to die from it than a non-smoker. These measurements were taken by trained health technicians, using standardized measuring procedures and equipment.
The data for adolescents are of notable concern because overweight adolescents are at increased risk to become overweight adults. Observations for persons missing a valid height or weight measurement were not included in the data analysis.
The 1999-2002 findings for children and adolescents suggest the likelihood of another generation of overweight adults who may be at risk for subsequent overweight and obesity related health conditions.
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