In August 2014 the world marks the 100th anniversary of the outbreak of the First World War. It is often said of this conflict that every family in Britain lost a loved one – a shocking level of loss – yet 100 years on, the cancer epidemic that we now face threatens us on a similar level. The difference is, there is something we can do about it, right now.
Around 325,000 people are diagnosed with cancer every year in the UK, and 160,000 people die as a result of it. Over 100,000 of those diagnosed are of working age, and estimates suggest that over 750,000 people of working age are currently living with a cancer diagnosis. In the UK at the moment about one in three people get cancer of one type in their lifetime, and the cancer charity Macmillan says that figure is expected to be almost one in two by the year 2020. In contrast with both world wars, it is women who are bearing the brunt of this.
The Department of Health has asked for the support of employers in the early detection of all cancers in its national plan entitled ‘Improving Outcomes’. However, the far more important point that employers need to be aware of is that, come what may, cancer will affect their employees or the partners of their employees – and therefore their business. At some point, they will have significant downtime from those employees, and if the cancer is only picked up at a later stage then it is going to require more treatment, more time off work, more time recovering from ongoing treatment and therefore will result in a reduction in productivity from that employee.
Companies and organisations can take positive action to increase awareness of cancer, educating employees on managing any risk factors and spotting symptoms, and initiating early screening programmes within the workplace. These can operate at a number of levels. At its simplest, such a programme may involve raising awareness and knowledge via a campaign of dedicated websites, posters and brochures. This is aimed at informing the individual sufficiently that they are aware of the risks, and know what to look for – essentially putting their health back in their hands.
Effective cancer screening at Hewlett Packard
At the top end of the scale is the example of Hewlett Packard, who, over a period of several years, commissioned HealthScreen UK to run workplace-based screening programmes for four of the most common cancers – breast, prostate, skin and lung cancer. The first of these campaigns – the Power of Pink breast cancer campaign – involved over 100,000 employees across the US and Europe, with screening being extended also to spouses and partners of employees. HealthScreen UK was chosen to work with HP in the UK, Sweden and Denmark. In each of these campaigns, anomalies were detected that otherwise may only have been picked up much later, or not at all.
Clearly, campaigns such as this can save lives. From the employer’s point of view, picking up a cancer several years earlier can also mean an employee getting back to work far quicker, doing the job you want them to do. So, early detection is better for the employee in terms of survival and outcome, and better for your company. Think of it in terms of the company’s business plan for the next five years. If it was known that an imminent financial downturn was likely, any prudent company would take action to protect itself. Cancer also threatens your business – and is not just likely, but inevitable. It would make good sense, therefore, for it to be part of every responsible company’s business plan.
Lifestyle factors affecting risk
There are, perhaps, other reasons why employers should take on some of this responsibility. When we consider why instances of cancer are increasing, it is clear most are due to changes in our lifestyles over the last 20-30 years, but many are also related to employment.
Let’s consider breast cancer. There are a number of lifestyle factors affecting risk. More women now drink alcohol, and consumption of alcohol is proportionally related to incidence of cancer. The population is in general more obese than it was several decades ago, and if you’re obese and post-menopausal, that also puts your risk up.
Some of the most significant factors, however, are reproductive. Women are starting their periods much younger, and finishing their periods much later than they used to – a change, somewhat paradoxically, driven by better general health and nutrition. We now know that the longer you have periods for in your lifetime, the greater the risk.
We also know that if you don’t have children, or you have your first child at a later age, that increases your risk. With the current pressure on women to work – and with increased desire to do so – an increasing number delay having their first child, or perhaps choose not to have children at all. In other words, even women who work in entirely benign environments and low-risk careers may be at increased risk because of work.
Identifying risk associated with occupational cancers
Then there are what we call occupational cancers – that is, cancers whose likelihood is increased as direct result of one’s work practices or environment. Around 10,000 cancers in the UK are thought to be work related. Some risk factors are well-known, such as exposure to radiation, asbestos or smoke. Others are less dramatic: those who work outdoors and have prolonged exposure to sunlight, for example, have an increased the risk of skin cancer.
A few are relatively little-known. Night shift work is now understood to increase cancer risk, as is working as part of a flight crew. Today, a higher number of women work shifts that involve working at night – it’s one of the ways that women can have children but still go to work – and a large proportion of flight crews are female. These are key reasons for increases in breast cancer (night shift work also increases the risk of prostate cancer in men).
Increasing survival rates
The good news is, we are successfully fighting back on several fronts. Recent statistics suggest we have reached the magic figure of 50% of people surviving for ten years following cancer treatment, signalling an increase in survival rates across all cancers. But the improvement is better in some cancers than others. If you take breast cancer, the reasons for the improvement are clear: there is a national breast screening programme, which means earlier detection, and we have had widespread awareness about it for at least 20 years. We probably understand more about breast cancer than any other – it’s one of the most researched cancers, and as a result we are getting better at picking up this cancer earlier, and better at treating it. While the incidence of breast cancer has been increasing, from about the mid-1980s the number of deaths from breast cancer has been steadily decreasing.
If we take lung cancer, however, it’s a different story. Most lung cancers present very late on, when they are at an advanced stage and cannot be treated by surgery. As a result, survival from lung cancer is still very poor. Although there is a pilot screening programme underway in Scotland, there is as yet no national lung cancer screening programme in the UK. There are also no national screening programmes for prostate cancer or skin cancer, and only limited screening for bowel cancer.
Encouraging early detection in the workplace
These are the kinds of early detection programmes we introduce into workplaces, complemented by educational campaigns. Such early detection programmes – of the kind run at Hewlett Packard – would normally be for a specific cancer. It may be, for example, that the company has a high proportion of men, so they request an early detection programme for prostate cancer. All have the same basic protocol.
The employee goes onto the online client management system, and answers some questions that allow us to estimate their personal risk of that cancer. Then we give them an appointment for a test – in the case of prostate cancer a simple blood test that looks at several bio-markers for that cancer. Wherever possible, such tests are carried out in the workplace itself, which is both convenient for the employee and means they have less time away from their desks. They receive the results and, if any anomalies are found they are referred for further investigation, either to their GP in the NHS, or to a consultant specialist in that field if they have private medical insurance.
The role of the workplace in cancer detection
From the point of view of the cancer specialist, workplaces are excellent environments in which to educate people. Reluctance to talk about cancer can be rapidly overcome; it becomes easy to talk about it because everyone is talking about it. They often they have a mix of sexes and ages, which means you are educating across a wide age range. While the majority of cancers increase in incidence the older you get, and tend to be something that affect middle-aged and older people, some of the risk factors that drive that increase start when you are younger, so there is a strong need to educate younger people.
One important message is that investing in the fight does make a real impact. There is a wealth of data that shows that the amount of GDP that is spent on health – and on cancer in particular – is directly proportional to survival. About 10-15 years ago, the UK spent less on cancer than many other countries, and survival figures were lower. Since then, we have spent more, and survival rates have gone up. But always, earlier detection greatly increases the chances of survival, and with an overburdened NHS currently unable to contemplate across-the-board screening programmes for many of the most common cancers, the role business has to play in this cannot be overestimated.
The future of the fight against cancer
‘Finding the cure for cancer’ has come to be seen as the holy grail of medicine. While that cure may still be a long way off, we are getting steadily better at treating it, and perhaps a change in our thinking about cancer is in order. Cancer is becoming more of a chronic disease – something that can be regarded in a similar way to conditions like rheumatoid arthritis. It can now be treated and managed in such a way that people can live for a long period of time with the disease – a far cry from 30 or 40 years ago when cancer was seen as effectively a death sentence. I firmly believe we can go much further, and, with the involvement of business, save many more lives. But we have to start now.
Over the next four years there will be much reflection on the loss of the First World War and what this now means to us. Of course, this is loss we cannot change – but history is worthless if it does not also teach us something for the future. So, while we remember and reflect, we can also become inspired to take positive actions that can – and will – avert significant loss of life. Hewlett Packard is a model for what can be achieved, but even something as simple as making a small workforce aware of the risks, how to manage them, and what to look for, can make a significant impact
Quite apart from the lives it may save, as an investment in a company’s own resource and an exercise in boosting brand image and strengthening staff loyalty, it is invaluable. It’s a powerful way for a company to demonstrate how it values its employees.
If we do rise to this challenge, future generations will have grounds not merely to remember and reflect on this effort, but to thank us for it – for in many cases, we will have made their lives possible.
Professor Gordon Wishart studied at Edinburgh University Medical School and trained in general, breast & endocrine surgery in the West of Scotland deanery. He recently led a team that developed and validated the new PREDICT breast cancer survival and treatment benefit model.
For more information on HealthScreen UK, go to www.healthscreenuk.com